Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Social and Health Systems Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Int J Geriatr Psychiatry. 2021 Apr;36(4):521-529. doi: 10.1002/gps.5447. Epub 2020 Oct 26.
Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression-specific treatment, and (3) inpatient psychiatric admission.
METHODS/DESIGN: Longitudinal analyses were based on data from three follow-up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self-reported at baseline of each follow-up cycle using the 12-item EURO-D scale. Health care utilization was self-reported at the end of each follow-up cycle.
After adjustment for sex, age, country of interview, follow-up time, educational attainment, presence of a partner in household, body-mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission.
Specific symptoms of depression may determine utilization of different types of health care among elderly.
许多患有抑郁症的老年人未得到充分治疗。治疗利用方面的差异可能反映出抑郁症的异质性，包含多种不同的症状。我们评估了抑郁症状是否与以下三种结果的后续医疗保健利用存在差异：（1）与医生（MD）的接触，（2）针对抑郁的治疗，和（3）住院精神科就诊。
方法/设计：纵向分析基于 2004 年至 2013 年期间在欧洲健康、老龄化和退休调查的 53139 名参与者的三次随访周期中的数据。使用 12 项 EURO-D 量表在每次随访周期的基线自我报告抑郁症状。在每次随访周期结束时自我报告医疗保健利用情况。
调整性别、年龄、访谈国家、随访时间、教育程度、家庭中有伴侣、体重指数、慢性病数量、残疾、与 MD 的平均/之前接触频率以及所有其他抑郁症状后，与 MD 接触更频繁的人更常报告睡眠问题（IRR = 1.10）和疲劳（IRR = 1.10），其次是悲伤/抑郁情绪、流泪、注意力问题、内疚、易怒和食欲变化。接受抑郁治疗的人更常报告悲伤/抑郁情绪（OR = 2.18）和自杀意念（OR = 1.72），但也报告了睡眠问题、食欲变化、疲劳、注意力问题、绝望和易怒。悲伤/抑郁情绪（OR = 2.87）也与精神科住院治疗有关。与其他结果类似，食欲改变、疲劳和睡眠问题与住院治疗有关。
抑郁的特定症状可能决定老年人对不同类型医疗保健的利用。
