Universidade Federal de São Paulo, Brazil.
Institute of Psychiatry, King's College London, United Kingdom.
J Affect Disord. 2019 Feb 15;245:120-125. doi: 10.1016/j.jad.2018.10.082. Epub 2018 Oct 6.
A new diagnosis of anxious depression (AD), characterized by both depressive and anxious symptoms at case level, has been proposed for the classification of mental disorders for primary care for ICD-11 (ICD-11 PHC). The ICD-11 PHC proposes a duration requirement for anxiety symptoms of 2 weeks, in line with the requirement for depressive symptoms. This study examined diagnostic assignment under ICD-11 PHC as compared to the previous classification, the ICD-10 PHC, and the relationship of anxiety duration to disability and suicidal ideation.
Primary care physicians in five countries referred patients based on either perceived psychological distress or distressing somatic symptoms to a research assistant who administered a computer-guided diagnostic interview. Complete data were obtained for 2279 participants.
Under ICD-11 PHC 47.7% participants received a diagnosis of AD and had greater disability than other diagnostic groups. Under ICD-10 PHC, in addition to meeting requirements for depressive episode, most of these patients met requirements for either generalized anxiety disorder (41.5%) or mixed anxiety and depressive disorder (45.4%). One third of individuals diagnosed with AD had anxiety durations between 2 weeks and 3 months and presented as much disability and suicidal ideation as individuals with longer anxiety durations.
The study was not designed to establish prevalence of these conditions.
The proposed ICD-11 PHC encourages early identification and management of significant anxiety symptoms in primary care, particularly when these co-occur with depression. This study provides support for the clinical relevance of these symptoms and the importance of early identification.
为了对初级保健中的精神障碍进行分类，ICD-11（ICD-11 PHC）提出了一种新的焦虑性抑郁症（AD）诊断，其特征是在病例层面上同时存在抑郁和焦虑症状。ICD-11 PHC 对焦虑症状的持续时间要求为 2 周，与抑郁症状的要求一致。本研究比较了 ICD-11 PHC 与之前的分类 ICD-10 PHC 的诊断分配，并探讨了焦虑持续时间与残疾和自杀意念的关系。
五个国家的初级保健医生根据感知到的心理困扰或困扰性躯体症状，将患者转介给研究助理，研究助理会对他们进行计算机引导的诊断访谈。共获得了 2279 名参与者的完整数据。
根据 ICD-11 PHC，47.7%的参与者被诊断为 AD，其残疾程度比其他诊断组更严重。根据 ICD-10 PHC，除了符合抑郁发作的要求外，这些患者中的大多数还符合广泛性焦虑症（41.5%）或混合性焦虑和抑郁障碍（45.4%）的要求。三分之一被诊断为 AD 的患者的焦虑持续时间在 2 周到 3 个月之间，其残疾程度和自杀意念与焦虑持续时间更长的患者一样多。
该研究并非旨在确定这些情况的患病率。
拟议的 ICD-11 PHC 鼓励在初级保健中及早识别和管理严重的焦虑症状，特别是当这些症状与抑郁同时出现时。本研究为这些症状的临床相关性和早期识别的重要性提供了支持。
