Scott George, Beauchamp-Lebrón Alessandra M, Rosa-Jiménez Ashley A, Hernández-Justiniano Javier G, Ramos-Lucca Axel, Asencio-Toro Gloria, Jiménez-Chávez Julio
Health Psychology Training and Research Core, School of Behavior and Brain Sciences, Ponce Health Sciences University, 388 Zona Industrial Reparada 2, Ponce, PR, 00717, USA.
Department of Behavioral Medicine, Damas Hospital, 2213 Ponce Bypass, Ponce, PR, 00717, USA.
Int J Ment Health Syst. 2021 Jun 19;15(1):61. doi: 10.1186/s13033-021-00484-w.
Considering many patients receive care from general hospitals, these healthcare institutions are uniquely situated to address mental and physical health needs. Little is documented, however, on the common current mental disorders diagnosed in patients receiving care in general hospital settings, especially in Puerto Rico. The objective of this study was to characterize the five most common current DSM-5 mental disorder diagnoses made in patients receiving non-psychiatric medical and surgical care from a general hospital system in southern Puerto Rico between January 2015 and December 2019.
Our clinical health psychology team provides integrated psychology consultation-liaison services to select clinical units in general hospitals across the southwestern region of Puerto Rico. The clinical team conducted routine standardized psychological evaluations at patients' bedside, arrived at a current DSM-5 diagnosis if warranted, and documented the diagnosis and other select variables. A retrospective study of cross-sectional data generated from the clinical team's standardized evaluations of 5494 medical patients was implemented. Multinomial logistic regression analyses were used to assess the odds of being diagnosed with a current DSM-5 mental disorder during hospitalization.
Overall, 53% of the entire sample was diagnosed with a mental disorder during hospitalization. Major depressive, neurocognitive, anxiety, substance-related and schizophrenia-spectrum disorders were the most frequently diagnosed. Interestingly, females were 23% less likely to have been diagnosed with major depressive disorder than males (aOR: 0.769, CI [0.650, 0.909], p = 0.002). This is to say males evidenced 1.30 higher odds of being diagnosed with depression compared to their female counterpart. Age, biological sex, civil status, employment status, monthly household income, previous mental disorder and history substance use/abuse history was differentially associated with receiving a current DSM-5 disorder.
The integration of clinical health psychology services within a general hospital facilitated our team's work of identifying and treating co-occurring mental disorders among hospitalized patients receiving medical and surgical care. Future studies examining the opportunities and barriers of integrating clinical health psychology services within a general hospital's administrative and clinical infrastructure for rapid identification and treatment of co-occurring mental disorders among medical patients is encouraged.
鉴于许多患者在综合医院接受治疗，这些医疗机构在满足患者身心健康需求方面具有独特的优势。然而，关于综合医院环境中接受治疗的患者目前常见的精神障碍的记录却很少，尤其是在波多黎各。本研究的目的是描述2015年1月至2019年12月期间在波多黎各南部一家综合医院系统接受非精神科医疗和外科治疗的患者中，目前最常见的五种DSM-5精神障碍诊断的特征。
我们的临床健康心理学团队为波多黎各西南部地区综合医院的选定临床科室提供综合心理会诊-联络服务。临床团队在患者床边进行常规标准化心理评估，如有必要，得出当前的DSM-5诊断，并记录诊断结果和其他选定变量。对临床团队对5494名内科患者进行标准化评估产生的横断面数据进行了回顾性研究。采用多项逻辑回归分析来评估住院期间被诊断为当前DSM-5精神障碍的几率。
总体而言，整个样本中有53%的患者在住院期间被诊断患有精神障碍。重度抑郁、神经认知、焦虑、物质相关和精神分裂症谱系障碍是最常被诊断出的疾病。有趣的是，女性被诊断为重度抑郁症的可能性比男性低23%（调整后比值比：0.769，可信区间[0.650, 0.909]，p = 0.002）。也就是说，与女性相比，男性被诊断为抑郁症的几率高1.30倍。年龄、生理性别、婚姻状况、就业状况、家庭月收入、既往精神障碍和物质使用/滥用史与当前接受DSM-5障碍诊断存在差异相关。
在综合医院中整合临床健康心理学服务有助于我们团队识别和治疗接受医疗和外科治疗的住院患者中同时存在的精神障碍。鼓励未来开展研究，探讨在综合医院的行政和临床基础设施中整合临床健康心理学服务以快速识别和治疗内科患者中同时存在的精神障碍的机会和障碍。
