基层医疗中与抑郁发作复发相关的因素：一项回顾性描述性研究。
Factors Associated With Depressive Episode Recurrences in Primary Care: A Retrospective, Descriptive Study.
作者信息
Nuggerud-Galeas Shysset, Oliván Blázquez Bárbara, Perez Yus María Cruz, Valle-Salazar Begoña, Aguilar-Latorre Alejandra, Magallón Botaya Rosa
机构信息
Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain.
Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
出版信息
Front Psychol. 2020 Jun 5;11:1230. doi: 10.3389/fpsyg.2020.01230. eCollection 2020.
INTRODUCTION AND OBJECTIVE
The early identification of depressive patients having a poor evolution, with frequent relapses and/or recurrences, is one of the priority challenges in this study of high prevalence mental disorders, and specifically in depression. So, this study aims to analyze the factors that may be associated with an increased risk of recurrence of major depression episodes in patients treated in primary care.
METHODS
A retrospective, descriptive study of cases-controls was proposed. The cases consisted of patients who had been diagnosed with major depression and who had presented recurrences ( = 101), in comparison with patients who had experienced a single major depression episode with no recurrence ( = 99). The variables of the study are age at first episode; number of episodes; perception of severity of the depression episode suffered prior to recurrence; number of residual symptoms; physical and psychiatric comorbidity; history of anxiety disorders; family psychiatric history; high incidence of stressful life events (SLEs); and experiences of physical, psychological, or sexual abuse in childhood. The differences of the variables were compared between the case subjects and the control subjects, using the Mann-Whitney, chi-square, and Fisher's U statistics. A multivariate analysis (ordinary logistic regression) was performed.
RESULTS
The average age of those suffering more than one depressive episode is significantly older (5 years), and a higher percentage of subjects who have experienced more than one depressive episode have a history of anxiety disorders. In the multivariate analysis, the variables that obtained a significant value in the logistic regression analysis were age (OR: 1.03; value: 0.007) and having suffered sexual abuse during childhood (OR: 1.64; value: 0.072).
CONCLUSION
These indicators should be considered by primary care physicians when attending patients suffering from major depression.
引言与目的
早期识别病情发展不佳、频繁复发和/或再发的抑郁症患者，是这项针对高患病率精神障碍（尤其是抑郁症）研究中的首要挑战之一。因此，本研究旨在分析与初级保健中接受治疗的患者重度抑郁发作复发风险增加可能相关的因素。
方法
提出一项病例对照的回顾性描述性研究。病例组由已被诊断为重度抑郁症且出现复发的患者（n = 101）组成，与经历过单次重度抑郁发作且未复发的患者（n = 99）进行比较。研究变量包括首次发作年龄；发作次数；复发前经历的抑郁发作严重程度感知；残留症状数量；躯体和精神共病情况；焦虑症病史；家族精神病史；应激性生活事件（SLE）高发率；以及童年期身体、心理或性虐待经历。使用曼-惠特尼检验、卡方检验和费舍尔精确检验比较病例组和对照组之间变量的差异。进行多变量分析（普通逻辑回归）。
结果
经历不止一次抑郁发作的患者平均年龄显著更大（5岁），且经历不止一次抑郁发作的患者中有更高比例有焦虑症病史。在多变量分析中，逻辑回归分析中获得显著值的变量是年龄（OR：1.03；P值：0.007）和童年期遭受性虐待（OR：1.64；P值：0.072）。
结论
初级保健医生在诊治重度抑郁症患者时应考虑这些指标。
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