Read Charlotte, Armstrong April W
Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles.
Department of Medicine, Imperial College London, London, United Kingdom.
JAMA Dermatol. 2020 Jul 1;156(7):754-762. doi: 10.1001/jamadermatol.2020.1054.
How patients' mental health is associated with their satisfaction with physicians is rarely studied among adults with skin conditions.
To examine the association between mental health comorbidities in patients with psoriasis and their satisfaction with physicians.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective survey analysis used 14 years of nationally representative longitudinal data on adults in the United States with psoriasis from the 2004-2017 Medical Expenditure Panel Survey. Statistical analysis was performed from October 1, 2018, to December 1, 2019. Mental health comorbidities were measured by performance on the Kessler 6-Item Psychological Distress Scale (score range, 0-24, where a score ≥13 is considered an indicator of a serious mental illness and significant psychological distress) and the Patient Health Questionnaire 2 (score range, 0-6, where a score ≥3 is considered a positive screening result for a depressive disorder).
Patient satisfaction with physician, measured by the patient-physician communication composite score.
A weighted total of 8 876 767 US adults with psoriasis (unweighted total, 652 patients) (weighted; 54% women; mean [SEM] age, 52.1 [0.7] years) were analyzed; 27% of adults had moderate or severe symptoms of psychological distress, and 21% had moderate or severe symptoms of depression. Patients with moderate or severe psychological distress symptoms were less satisfied with their clinicians compared with those with no or mild psychological distress symptoms (mean Kessler 6-Item Psychological Distress Scale scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 13.0-13.4]; and severe symptoms, 13.1 [95% CI, 12.5-13.7]; P < .001). In addition, compared with patients with no or mild psychological distress symptoms, patients with moderate psychological distress symptoms were 2.8 times more likely to report low patient satisfaction (adjusted odds ratio, 2.8 [95% CI, 1.5-4.9]; P = .001), and patients with severe psychological distress symptoms were 2.3 times more likely to report low patient satisfaction (adjusted odds ratio, 2.3 [95% CI, 1.1-4.7]; P = .03). Furthermore, patients with moderate or severe depression symptoms were less satisfied with their clinicians compared with those with no or mild depression symptoms (mean Patient Health Questionnaire 2 scores for no or mild symptoms, 14.3 [95% CI, 14.2-14.4]; moderate symptoms, 13.2 [95% CI, 12.9-13.6]; and severe symptoms, 13.0 [95% CI, 12.6-13.4]; P = .002). In addition, compared with patients with no or mild depression symptoms, patients with moderate depression symptoms were 4.6 times more likely to report low patient satisfaction (adjusted odds ratio, 4.6 [95% CI, 2.1-10.0]; P < .001).
This study suggests that patients with greater psychological distress and depression report lower satisfaction with their clinicians than those without such mental health symptoms. Clinicians need to be adaptable and supportive when communicating with patients with mental health comorbidities. Evaluating clinician performance solely based on patient satisfaction can be problematic and incomplete.
在患有皮肤病的成年人中，患者心理健康与他们对医生满意度之间的关联很少被研究。
研究银屑病患者的心理健康合并症与其对医生满意度之间的关联。
设计、背景和参与者：这项回顾性调查分析使用了2004 - 2017年医疗支出面板调查中关于美国成年银屑病患者的14年全国代表性纵向数据。统计分析于2018年10月1日至2019年12月1日进行。心理健康合并症通过凯斯勒6项心理困扰量表（得分范围0 - 24分，得分≥13分被认为是严重精神疾病和显著心理困扰的指标）和患者健康问卷2（得分范围0 - 6分，得分≥3分被认为是抑郁症的阳性筛查结果）来衡量。
通过患者 - 医生沟通综合得分来衡量患者对医生的满意度。
对加权总计8876767名美国成年银屑病患者（未加权总计652名患者）（加权后；54%为女性；平均[标准误]年龄52.1[0.7]岁）进行了分析；27%的成年人有中度或重度心理困扰症状，21%的成年人有中度或重度抑郁症状。与没有或有轻度心理困扰症状的患者相比，有中度或重度心理困扰症状的患者对临床医生的满意度较低（凯斯勒6项心理困扰量表中没有或有轻度症状的平均得分，14.3[95%置信区间，14.2 - 14.4]；中度症状，13.2[95%置信区间，13.0 - 13.4]；重度症状，13.1[95%置信区间，12.5 - 13.7]；P <.001）。此外，与没有或有轻度心理困扰症状的患者相比，有中度心理困扰症状的患者报告低患者满意度的可能性高2.8倍（调整后的优势比，2.8[95%置信区间，1.5 - 4.9]；P =.001），有重度心理困扰症状的患者报告低患者满意度的可能性高2.
