Department of Regional Health Care Analysis and Health Care Atlas, Central Research Institute of Ambulatory Health Care in Germany (Zi).
Unit 26 Mental Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
J Affect Disord. 2020 Jun 15;271:239-247. doi: 10.1016/j.jad.2020.03.082. Epub 2020 Apr 18.
Studies based on health insurance funds unanimously indicate a rise in administrative prevalence of depression, while population surveys with standardized diagnostic procedures do not. We describe recent trends in the prevalence of depressive disorders as diagnosed in routine care from 2009-2017 in Germany.
We used nationwide ambulatory claims data from all residents with statutory health insurance, covering 87% of the total population. Cases were defined as persons with at least one documented diagnosis of depression (ICD-10-GM codes: F32, F33 or F34.1). The administrative prevalence was computed for each year according to age, sex, degree of urbanization and severity of depression diagnosis.
The prevalence increased from 12.5% in 2009 to 15.7% in 2017 (+26%). Overall, women were twice as likely as men to receive a diagnosis, although the prevalence increased more strongly in men compared to women (+40% vs. +20%). Age- and sex-stratified analyses revealed the highest prevalence increase in adolescents and young men at the ages of 15-19 years (+95%) and 20-25 years (+72%). Rural areas with a low population density showed the highest rise in administrative prevalence (+34%), while big urban municipalities showed the lowest (+25%).
Administrative claims data rely on diagnoses coded for billing purposes and thus depend on coding practice as well as patients' help seeking behavior.
Depressive disorders are of increasing importance in ambulatory health care in Germany. Parts of the increase may be attributed to changing cultural constructions of mental health along with the expansion of mental health care supply.
基于健康保险基金的研究一致表明，抑郁症的行政患病率上升，而采用标准化诊断程序的人群调查则没有。我们描述了 2009 年至 2017 年期间德国常规护理中诊断为抑郁障碍的最新患病率趋势。
我们使用了来自所有参加法定健康保险的居民的全国性门诊理赔数据，涵盖了总人口的 87%。病例定义为至少有一次记录的抑郁症诊断的人（ICD-10-GM 代码：F32、F33 或 F34.1）。根据年龄、性别、城市化程度和抑郁症诊断严重程度，每年计算行政患病率。
患病率从 2009 年的 12.5%上升到 2017 年的 15.7%（增加了 26%）。总体而言，女性被诊断出抑郁症的可能性是男性的两倍，尽管男性的患病率增长更为强劲（增加 40%，而女性增加 20%）。按年龄和性别分层分析显示，15-19 岁和 20-25 岁的青少年和年轻男性患病率增幅最高（分别增加 95%和 72%）。人口密度低的农村地区行政患病率上升幅度最高（增加 34%），而人口稠密的大城市则上升幅度最低（增加 25%）。
行政理赔数据依赖于为计费目的编码的诊断，因此取决于编码实践以及患者寻求帮助的行为。
在德国，门诊医疗保健中抑郁障碍的重要性日益增加。部分增长可能归因于心理健康文化观念的变化以及心理健康保健供应的扩大。
