Saint Louis University School of Medicine, St Louis, MO, USA.
Division of Vascular and Endovascular Surgery, Saint Louis University School of Medicine, St Louis, MO, USA.
Vascular. 2023 Aug;31(4):758-766. doi: 10.1177/17085381221084817. Epub 2022 Apr 11.
Major depression is associated with increased morbidity and mortality in vascular surgery patients. The US Preventive Services Task Force and American Heart Association recommend routine depression screening for adults, especially those with cardiovascular disease. Since routine depression screening has not been implemented in most vascular surgery clinics across the nation, we sought to determine the feasibility of depression screening and understand the prevalence and predictors of depression in patients presenting to a single institution's vascular surgery clinic over a 4 month period.
From June to September 2020, vascular surgery clinic patients were administered a 26-item survey that included validated scales for depression (PHQ-9), pain, frailty, alcohol dependence, and nicotine dependence. Although not validated, the Rosenberg Self-Esteem Scale was also administered. Patient charts were reviewed for demographic information and medical history. 9-digit patient zip codes were used to determine Area Deprivation Index, a measure of socioeconomic status. Univariate and multivariate analyses were performed to understand the factors associated with increased depression prevalence in the study population.
A total of 140 (36.4%) of 385 patients met study inclusion criteria. 35.7% of them screened positive for mild to severe depression (PHQ-9 scores ≥5). On univariate analysis, major depression was significantly associated with lower socioeconomic status ( = 0.007), higher frailty ( < 0.001), lower self-esteem ( < 0.001), higher daily pain ( < 0.001), health problems that interfere with social activities ( < 0.001), fatigue ( < 0.001), unmarried status ( = 0.031), and lack of primary care provider ( = 0.048). Multivariate analyses significantly predicted higher frailty (B= 0.487, = 0.007) and lower self-esteem (B= -0.413, < 0.001) in patients with depression. Depression was not associated with gender, age, employment status, smoking status, alcohol use, or type of vascular disease.
More than one-third of vascular surgery clinic patients have comorbid depression. Higher frailty and lower self-esteem are significant risk factors for depression. Prevention and early identification of frailty may improve outcomes. Depression screening in vascular surgery clinics is feasible and could be useful in determining which patients may benefit from more frequent follow-up and monitoring for associated comorbidities. Vascular surgeons may play an important role in screening for depression and referring patients for psychotherapy and/or pharmacotherapy.
重度抑郁症与血管外科患者的发病率和死亡率增加有关。美国预防服务工作组和美国心脏协会建议对成年人进行常规抑郁筛查，尤其是心血管疾病患者。由于常规抑郁筛查尚未在全美大多数血管外科诊所实施，因此我们旨在确定抑郁筛查的可行性，并了解在单一机构血管外科诊所就诊的患者在 4 个月期间的抑郁发生率和预测因素。
2020 年 6 月至 9 月，对血管外科诊所患者进行了一项 26 项的调查，其中包括抑郁（PHQ-9）、疼痛、虚弱、酒精依赖和尼古丁依赖的有效量表。尽管尚未经过验证，但也使用了罗森伯格自尊量表。查阅患者病历以获取人口统计学信息和病史。使用 9 位数字的患者邮政编码来确定社会经济地位的衡量指标——区域贫困指数。进行单变量和多变量分析，以了解与研究人群中抑郁发生率增加相关的因素。
共有 385 名患者中的 140 名（36.4%）符合研究纳入标准。其中 35.7%的患者筛查出轻度至重度抑郁（PHQ-9 得分≥5）。单变量分析显示，重度抑郁症与较低的社会经济地位显著相关（ = 0.007），更高的脆弱性（ < 0.001），较低的自尊心（ < 0.001），更高的日常疼痛（ < 0.001），健康问题会干扰社交活动（ < 0.001），疲劳（ < 0.001），未婚状态（ = 0.031）和缺乏初级保健提供者（ = 0.048）。多变量分析显著预测了抑郁患者的更高脆弱性（B= 0.487， = 0.007）和较低自尊心（B= -0.413， < 0.001）。抑郁与性别、年龄、就业状况、吸烟状况、饮酒状况或血管疾病类型无关。
超过三分之一的血管外科诊所患者患有共病性抑郁症。更高的脆弱性和更低的自尊心是抑郁的重要危险因素。预防和早期发现脆弱性可能会改善预后。在血管外科诊所进行抑郁筛查是可行的，这可能有助于确定哪些患者可能受益于更频繁的随访和监测相关合并症。血管外科医生可能在筛查抑郁和转介患者接受心理治疗和/或药物治疗方面发挥重要作用。
