创伤性脊髓损伤成年人的心理病态和慢性病：私人保险受益人的纵向队列研究。
Psychological Morbidity and Chronic Disease Among Adults With Traumatic Spinal Cord Injuries: A Longitudinal Cohort Study of Privately Insured Beneficiaries.
机构信息
Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.
Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI; Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI.
出版信息
Mayo Clin Proc. 2020 May;95(5):920-928. doi: 10.1016/j.mayocp.2019.11.029. Epub 2020 Apr 13.
OBJECTIVE
To compare the longitudinal incidence of psychological morbidities and multimorbidity and estimates of chronic diseases among adults with spinal cord injuries (SCIs) as compared with adults without SCIs.
METHODS
Privately insured beneficiaries who had medical coverage at any time between January 1, 2001, and December 31, 2017 were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for a traumatic SCI (n=6,847).
RESULTS
Adults with SCIs (n=6847) had a higher incidence of adjustment reaction (7.2% [n=493] vs 5.0% [n=42,862]), anxiety disorders (19.3% [n=1,322] vs 14.1% [n=120,872]), depressive disorders (29.3% [n=2,006] vs 9.3% [n=79,724]), alcohol dependence (2.4% [n=164] vs 1.0% [n=8,573]), drug dependence (2.3% [n=158] vs 0.8% [n=6,858]), psychogenic pain (1.0% [n=69] vs 0.2% [n=1,715]), dementia (6.5% [n=445] vs 1.5% [n=12,859]), insomnia (10.9% [n=746] vs 7.2% [n=61,722]), and psychological multimorbidity (37.4% [n=2,561] vs 23.9% [n=204,882]) as compared with adults without SCIs (n=857,245). The adjusted hazard ratios (HRs) of each psychological outcome were significantly higher for individuals with SCI and ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain. Adults with SCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (51.1% vs 14.1%), except human immunodeficiency virus infection/AIDS. After propensity matching for age, education, race, sex, and chronic diseases (n=5884 matched pairs), there was still a significantly higher incidence of most psychological disorders and psychological multimorbidity among adults with SCIs.
CONCLUSION
Adults with traumatic SCIs experienced an increased incidence of psychological morbidities and multimorbidity as compared with adults without SCIs. Clinical efforts are needed to improve mental health screening and targeted interventions to reduce the risk for psychological disease onset in the traumatic SCI population.
目的
与无脊髓损伤（SCI）的成年人相比，比较有脊髓损伤成年人的心理障碍和共病的纵向发病率以及慢性病的预估发病率。
方法
纳入在 2001 年 1 月 1 日至 2017 年 12 月 31 日期间任何时间都有医疗覆盖的私人保险受益人，条件是他们有国际疾病分类，第九版，临床修正诊断代码创伤性 SCI（n=6847）。
结果
有脊髓损伤的成年人（n=6847）的调整反应发生率较高（7.2%[n=493]vs 5.0%[n=42862]），焦虑障碍（19.3%[n=1322]vs 14.1%[n=120872]），抑郁障碍（29.3%[n=2006]vs 9.3%[n=79724]），酒精依赖（2.4%[n=164]vs 1.0%[n=8573]），药物依赖（2.3%[n=158]vs 0.8%[n=6858]），心理性疼痛（1.0%[n=69]vs 0.2%[n=1715]），痴呆（6.5%[n=445]vs 1.5%[n=12859]），失眠（10.9%[n=746]vs 7.2%[n=61722]）和心理共病（37.4%[n=2561]vs 23.9%[n=204882]），与无脊髓损伤的成年人（n=857245）相比。脊髓损伤个体的每种心理结果的调整后危险比（HR）均显著更高，焦虑障碍为 1.18（95%CI，1.08-1.29），心理性疼痛为 3.32（95%CI，1.93-5.71）。有脊髓损伤的成年人还患有所有慢性病和慢性病共病的发病率明显更高（51.1%vs 14.1%），除了人类免疫缺陷病毒感染/艾滋病。在对年龄、教育程度、种族、性别和慢性病进行倾向匹配后（n=5884 对匹配对），脊髓损伤成年人的大多数心理障碍和心理共病发病率仍显著更高。
结论
与无脊髓损伤的成年人相比，有创伤性脊髓损伤的成年人经历了更高的心理障碍和共病发病率。需要进行临床努力以改善心理健康筛查和有针对性的干预措施，以降低创伤性脊髓损伤人群心理疾病发病的风险。
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