University of Texas, Austin, USA.
Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA, 19355, USA.
BMC Psychiatry. 2022 Aug 11;22(1):542. doi: 10.1186/s12888-022-04165-x.
Depression (major depressive disorder [MDD]) affects the functioning of patients in many facets of life. Very few large-scale studies to date have compared health and economic related outcomes of those with versus without depression, and across various depression severity groups. We aimed to evaluate humanistic and economic burden in respondents with and without depression diagnosis, and across symptom severity groups.
Data from the 2017 US National Health and Wellness Survey (NHWS) were utilized. Of the adult respondents (N = 75,004), 59,786 were < 65 years old. Respondents not meeting eligibility criteria were excluded (e.g., those self-reporting bipolar disorder or experiencing depression in past 12 months but no depression diagnosis). Overall, data from 39,331 eligible respondents (aged 18-64 years) were analyzed; and comprised respondents 'with depression diagnosis' (n = 8853; self-reporting physician diagnosis of depression and experiencing depression in past 12 months) and respondents 'without depression diagnosis' (n = 30,478; no self-reported physician diagnosis of depression and not experiencing depression). Respondents with depression were further examined across depression severity based on Patient Health Questionnaire-9 (PHQ-9). Outcome measures included health-related quality-of-life (HRQoL; Medical Outcomes Study 36-item Short Form [SF-36v2]: mental and physical component summary [MCS and PCS]; Short-Form 6 Dimensions [SF-6D]; and EuroQol 5 Dimensions [EQ-5D]), work productivity and activity impairment (WPAI), and health resource utilization (HRU). Multivariate analysis was performed to examine group differences after adjusting covariates.
Respondents with depression diagnosis reported significantly higher rates of diagnosed anxiety and sleep problems versus those without depression (for both; P < 0.001). Adjusted MCS, PCS, SF-6D, and EQ-5D scores were significantly lower in respondents with depression versus those without depression (all P < 0.001). Consistently, respondents with depression reported higher absenteeism, presenteeism, and overall WPAI, as well as greater number of provider visits, emergency room visits, and hospitalizations compared with those without depression (all P < 0.001). Further, burden of each outcome increased with an increase in disease severity.
Diagnosed depression was associated with lower health-related quality-of-life and work productivity, and higher healthcare utilization than those without depression, and burden increased with an increase in symptom severity. The results show the burden of depression remains high even among those experiencing minimal symptoms.
抑郁症（重度抑郁症[MDD]）影响患者生活的许多方面的功能。迄今为止，很少有大规模的研究比较有和没有抑郁症的患者的健康和经济相关结果，以及不同的抑郁症严重程度组。我们旨在评估有和没有抑郁症诊断的患者以及不同症状严重程度组的人文和经济负担。
利用了 2017 年美国国家健康和健康调查（NHWS）的数据。在成年受访者（N=75004）中，59786 岁<65 岁。不符合资格标准的受访者被排除在外（例如，自我报告双相情感障碍或在过去 12 个月内经历过抑郁症但没有抑郁症诊断的人）。总体而言，分析了 39331 名符合条件的受访者（18-64 岁）的数据；并包括有抑郁症诊断的受访者（n=8853；自我报告的医生诊断为抑郁症并在过去 12 个月内经历过抑郁症）和没有抑郁症诊断的受访者（n=30478；没有自我报告的医生诊断为抑郁症并且没有经历过抑郁症）。根据患者健康问卷-9（PHQ-9），进一步检查了有抑郁症的患者的抑郁症严重程度。结果测量包括健康相关生活质量（HRQoL；医疗结果研究 36 项简短形式[SF-36v2]：心理和生理成分综合[MCS 和 PCS]；简短 6 维度[SF-6D]；以及欧洲五维健康量表[EQ-5D]）、工作生产力和活动障碍（WPAI）以及卫生资源利用（HRU）。进行了多变量分析，以调整协变量后检查组间差异。
与没有抑郁症的患者相比，有抑郁症诊断的患者报告的焦虑和睡眠问题诊断率明显更高（均 P<0.001）。与没有抑郁症的患者相比，有抑郁症诊断的患者的调整后 MCS、PCS、SF-6D 和 EQ-5D 评分明显较低（均 P<0.001）。同样，与没有抑郁症的患者相比，有抑郁症的患者报告的旷工、出勤和整体 WPAI 更高，以及就诊次数、急诊室就诊次数和住院次数更多（均 P<0.001）。此外，随着疾病严重程度的增加，每种结果的负担都在增加。
与没有抑郁症的患者相比，有抑郁症诊断的患者的健康相关生活质量和工作生产力较低，医疗保健利用率较高，并且随着症状严重程度的增加负担也会增加。结果表明，即使是症状轻微的患者，抑郁症的负担仍然很高。
