Rana Ashhub H, Babar Osama
Psychiatry, Railway General Hospital, Rawalpindi, PAK.
Dermatology, Islamic International Medical College (Riphah International University), Rawalpindi, PAK.
Cureus. 2020 Oct 18;12(10):e11030. doi: 10.7759/cureus.11030.
According to the World Health Organization (WHO), chronic diseases are the leading cause of death and disability worldwide and estimated to contribute to 73% of all deaths by 2020. In addition to the difficulty in effectively managing chronic diseases, they are often complicated further by the co-morbid depression stemming from the original disease. Depression has the highest burden of disease affecting more than 264 million people worldwide and worsens the burden of co-existing chronic medical diseases as well. A bidirectional relation exists between depression and chronic medical diseases. Statistical mapping of chronically ill patients of Pakistan suggests that 50% of its population suffers from some form of chronic disease. Little data exists for the prevalence of depression in chronically ill patients from most of Pakistan. Our objectives were to observe the patterns of depression in chronically ill patients and outline the need for intervention (if any) on a population of Railway General Hospital (RGH - a tertiary healthcare hospital in Rawalpindi, Pakistan). We also aimed at finding out the relation (if any) of age, gender, number of hospital admissions, education and effectiveness of medical disease management with depression. A cross sectional study was conducted on patients admitted due to their chronic medical diseases out of a population of 11,000 presenting at the medical OPD of RGH over a period of three months using Patient Health Questionnaire-9 (PHQ -9) Urdu version. About 50% of the patients suffered from moderate to severe forms of depression. A significant positive correlation was found between age and past psychiatric history of illnesses other than depression with depression while no significance was found with number of hospital admissions, gender or education level; 35% had suicidal ideation. Depression is quite often dismissed, underdiagnosed and leads to a poor quality of life and decrease in cost effectiveness in our population. Pakistan needs to use more resources on managing depression and medical professionals need to change their attitudes in holistically managing the patients. Treating depression is just as important as managing other symptoms of chronic medical diseases.
根据世界卫生组织（WHO）的数据，慢性病是全球死亡和残疾的主要原因，预计到2020年将占所有死亡人数的73%。除了难以有效管理慢性病外，慢性病还常常因原发病引发的共病抑郁症而进一步复杂化。抑郁症是疾病负担最高的疾病，全球有超过2.64亿人受其影响，同时也加重了并存慢性疾病的负担。抑郁症与慢性疾病之间存在双向关系。巴基斯坦慢性病患者的统计数据表明，该国50%的人口患有某种形式的慢性病。巴基斯坦大部分地区慢性病患者中抑郁症患病率的数据很少。我们的目标是观察慢性病患者的抑郁模式，并概述对巴基斯坦拉瓦尔品第一家三级医疗医院——铁路总医院（RGH）的患者群体进行干预（如有必要）的需求。我们还旨在找出年龄、性别、住院次数、教育程度以及慢性病管理效果与抑郁症之间的关系（如有）。在三个月的时间里，我们使用乌尔都语版的患者健康问卷9（PHQ -9）对RGH内科门诊11000名患者中因慢性病入院的患者进行了横断面研究。约50%的患者患有中度至重度抑郁症。年龄与除抑郁症外的其他精神疾病既往史与抑郁症之间存在显著正相关，而与住院次数、性别或教育程度无关；35%的患者有自杀意念。在我们的人群中，抑郁症常常被忽视、诊断不足，导致生活质量低下和成本效益降低。巴基斯坦需要在抑郁症管理上投入更多资源，医学专业人员需要改变他们全面管理患者的态度。治疗抑郁症与管理慢性病的其他症状同样重要。
