German P S, Shapiro S, Skinner E A, Von Korff M, Klein L E, Turner R W, Teitelbaum M L, Burke J, Burns B J
JAMA. 1987;257(4):489-93.
Evidence is accruing that older individuals receive little attention for mental health problems and that any attention that is given is most often within the primary care setting. A randomized clinical trial was carried out at a primary care clinic of The Johns Hopkins University, Baltimore, testing the ability of feedback of the results of a screening instrument (the General Health Questionnaire) to increase awareness in clinicians of the emotional and psychological problems of their patients. This report contrasts those aged 65 years and older with younger patients. Detection and management of mental morbidity were lower for older individuals, but the feedback intervention increased the likelihood of attention to these problems. This was not true for younger patients. Detection was significantly higher for older patients when screening data were made available, as was management, although the latter difference was not statistically significant. There was evidence as well that the intervention moved clinicians to greater congruence with their older patients in the perception that current mental health problems existed. These findings have important implications for primary care.
越来越多的证据表明，老年人的心理健康问题很少受到关注，而且即便受到关注，也大多是在初级保健机构中。在巴尔的摩约翰·霍普金斯大学的一家初级保健诊所进行了一项随机临床试验，测试一种筛查工具（一般健康问卷）的结果反馈能否提高临床医生对患者情绪和心理问题的认知。本报告将65岁及以上的老年人与年轻患者进行了对比。老年人对精神疾病的检测和管理水平较低，但反馈干预增加了关注这些问题的可能性。年轻患者则并非如此。当提供筛查数据时，老年患者的检测率显著更高，管理情况也是如此，尽管后者的差异在统计学上并不显著。还有证据表明，该干预使临床医生在对当前存在心理健康问题的认知上与老年患者的认知更加一致。这些发现对初级保健具有重要意义。
