Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
J Pain Symptom Manage. 2019 Mar;57(3):587-595. doi: 10.1016/j.jpainsymman.2018.11.024. Epub 2018 Dec 1.
Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival.
Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics.
This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription).
Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88).
Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.
癌症患者常伴有抑郁。如果不加以处理，抑郁可能会导致生活质量下降和生存率降低。
鉴于国家发起了旨在改善癌症患者精神症状管理的计划，我们研究了抑郁的检出和治疗模式随时间的变化情况，并探讨了患者特征对此的影响。
这项横断面研究将 2005 年至 2013 年期间在 Kaiser Permanente Northern California 被诊断患有乳腺癌的女性患者前瞻性队列研究（Pathways 研究）的数据与 Kaiser Permanente Northern California 的电子病历数据进行了关联。符合本分析条件的 Pathways 参与者既往无抑郁病史，但在基线时报告有抑郁症状。我们使用改良泊松回归评估癌症诊断年份和其他患者特征与记录在案的临床医生对抑郁症状的反应（抑郁诊断、心理健康转诊或抗抑郁药物处方）之间的关联。
在我们的样本中，725 名女性中有 34%接受了临床医生对抑郁的反应。我们未观察到乳腺癌诊断年份与临床医生反应之间存在统计学显著关联。与临床医生反应相关的特征包括亚洲种族（调整后的风险比，亚洲人比白人：0.44，95%CI：0.29-0.68）和抑郁严重程度（调整后的风险比，轻度-中度抑郁比重度抑郁：1.45，95%CI：1.11-1.88）。
在我们的样本中，大多数患者未对其研究报告的抑郁接受临床医生的反应，且反应率似乎并未随时间而提高。亚洲女性以及抑郁程度较轻的患者似乎面临更大的未满足的精神卫生保健需求风险。
