Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
J Hand Surg Am. 2021 Feb;46(2):99-105. doi: 10.1016/j.jhsa.2020.10.012. Epub 2020 Dec 1.
We aimed to test the utility of screening for depressive symptoms in the hand surgical office focusing on chances of heightened depressive symptoms in patients with no history of diagnosed depression and by quantifying ongoing depressive symptoms among patients diagnosed with depression accounting for antidepressant use. The clinical importance of this study was predicated on the documented negative association between depressive symptoms and hand surgical outcomes.
This cross-sectional study analyzed 351 patients presenting to a tertiary hand center between April 21, 2016, and November 22, 2017. Adult patients completed self-administered Patient-Reported Outcomes Measurement Information System (PROMIS) Depression computer adaptive tests at registration. Health records were examined for a past medical history of diagnosed depression and whether patients reported current use of prescription antidepressants. Mean PROMIS Depression scores were compared by analysis of variance (groups: no diagnosed depression, depression without medication, depression with medication). Four points represented a clinically relevant difference in PROMIS Depression scores between groups and Depression scores greater than 59.9 were categorized as having heightened depressive symptoms.
Sixty-two patients (18%) had been diagnosed with depression. Thirty-four of these patients (55%) reported taking antidepressant medications. The PROMIS Depression scores indicated greater current depressive symptoms among patients with a history of diagnosed depression when not taking antidepressants (11 points worse than unaffected) and also among patients taking antidepressants (7 points worse than unaffected). Heightened depressive symptoms were detected in all groups but were more prevalent among those diagnosed with depression (36% with no medication, 29% with antidepressant medication) compared with unaffected patients (7%).
Depression screening for heightened depressive symptoms identifies 1 in 14 patients without diagnosed depression and 1 in 3 patients diagnosed with depression as having currently heightened depressive symptoms. Hand surgeons can use PROMIS Depression screening in all patients and using this to guide referrals for depression treatment to ameliorate one confounder of hand surgical outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Symptom prevalence study II.
我们旨在测试在手部外科诊室中筛查抑郁症状的效用，重点关注无抑郁诊断史的患者出现更严重抑郁症状的可能性，并量化正在接受抗抑郁药物治疗的抑郁诊断患者的持续抑郁症状。这项研究的临床重要性基于抑郁症状与手部外科手术结果之间存在的负面关联。
本横断面研究分析了 2016 年 4 月 21 日至 2017 年 11 月 22 日期间在一家三级手部中心就诊的 351 名患者。成年患者在登记时完成了患者报告的结局测量信息系统（PROMIS）抑郁计算机自适应测试。检查了病历中是否有确诊的抑郁病史以及患者是否报告正在使用处方抗抑郁药。通过方差分析（无确诊抑郁组、无药物治疗抑郁组、药物治疗抑郁组）比较了 PROMIS 抑郁评分的平均值。两组间 PROMIS 抑郁评分相差 4 分具有临床相关差异，抑郁评分大于 59.9 分被归类为存在更严重的抑郁症状。
62 名患者（18%）被诊断为抑郁。其中 34 名患者（55%）报告正在服用抗抑郁药物。PROMIS 抑郁评分显示，未服用抗抑郁药物的有确诊抑郁史的患者当前抑郁症状更严重（比未受影响的患者差 11 分），且服用抗抑郁药物的患者也更严重（比未受影响的患者差 7 分）。所有组均检测到更严重的抑郁症状，但在无药物治疗的患者中（36%）和服用抗抑郁药物的患者中（29%）更为普遍，而在未受影响的患者中（7%）则不那么普遍。
针对更严重的抑郁症状进行的抑郁筛查，发现 14 名无确诊抑郁史的患者中有 1 名，3 名被诊断为抑郁的患者中有 1 名当前存在更严重的抑郁症状。手部外科医生可以在所有患者中使用 PROMIS 抑郁筛查，并以此来指导抑郁治疗转诊，以改善手部外科手术结果的一个混杂因素。
研究类型/证据水平：症状流行率研究 II。
