全科医生对精神困扰患者的识别：一项来自挪威城市全科医疗的问卷与队列联合研究。
GPs' identification of patients with mental distress: a coupled questionnaire and cohort study from norwegian urban general practice.
作者信息
Dahli Mina P, Haavet Ole R, Ruud Torleif, Brekke Mette
机构信息
Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Kirkeveien 166 Fredrik Holst Hus, 0450, Oslo, Norway.
Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
出版信息
BMC Prim Care. 2022 Oct 9;23(1):260. doi: 10.1186/s12875-022-01865-x.
BACKGROUND
Mental health problems are one of the leading causes of disease burden worldwide, and are mainly diagnosed and treated in general practice. It is unclear however, how general practitioners (GPs) identify mental health problems in their patients. The aim of this study was to explore how patients' self-reported levels of mental distress correspond with psychological diagnoses made by their GPs, and associations with sex, age, number of consultations, and somatic symptom diagnoses.
METHODS
A questionnaire study coupled with retrospective and prospective cohort data from 553 patients aged 16-65 years in six GP offices in Oslo, Norway during 21 months in 2014-2016.
RESULTS
We found that 73.3% of patients with self-reported high levels of mental distress versus only 13.3% of the patients with low levels of mental distress had received a psychological diagnosis (p < 0.01). We found an increase in number of consultations for the group with high levels of mental distress regardless of having received a psychological diagnosis (p < 0.01). There was also an increase in number of somatic symptoms (p = 0.04) and higher number of females (0.04) in this group. 35% of patients had received one or more psychological diagnosis by their GP. Mean CORE-10 score, being female and a high number of consultations was associated with having received a psychological diagnosis. In the adjusted analyses high CORE-10 score and a high number of consultations still predicted a psychological diagnosis.
CONCLUSIONS
We found a clear association between self-reported mental distress and having received a psychological diagnosis amongst the participants, and the probability for being identified increased with increasing levels of mental distress, and increasing number of visits to their doctor. This suggests that GPs can identify patients with high levels of mental distress in general practice in an adequate way, even though this can sometimes be a complex issue.
TRIAL REGISTRATION
Trial registration The main study was retrospectively registered in ClinicalTrials.gov on August 10 2019 with identification number NCT03624829.
背景
心理健康问题是全球疾病负担的主要原因之一，主要在全科医疗中进行诊断和治疗。然而，全科医生（GP）如何识别患者的心理健康问题尚不清楚。本研究的目的是探讨患者自我报告的心理困扰水平与全科医生做出的心理诊断之间的对应关系，以及与性别、年龄、就诊次数和躯体症状诊断的关联。
方法
2014年至2016年期间，在挪威奥斯陆的6个全科医疗办公室对553名年龄在16至65岁之间的患者进行了问卷调查，并结合回顾性和前瞻性队列数据。
结果
我们发现，自我报告心理困扰水平高的患者中有73.3%接受了心理诊断，而心理困扰水平低的患者中只有13.3%接受了心理诊断（p<0.01）。我们发现，无论是否接受过心理诊断，心理困扰水平高的组就诊次数都有所增加（p<0.01）。该组的躯体症状数量也有所增加（p=0.04），女性数量更多（0.04）。35%的患者接受了全科医生的一项或多项心理诊断。CORE-10平均得分、女性身份和就诊次数多与接受心理诊断有关。在调整分析中，CORE-10得分高和就诊次数多仍然可以预测心理诊断。
结论
我们发现参与者中自我报告的心理困扰与接受心理诊断之间存在明显关联，被识别的可能性随着心理困扰水平的增加和就诊次数的增加而增加。这表明，全科医生在全科医疗中能够以适当的方式识别心理困扰水平高的患者，尽管这有时可能是一个复杂的问题。
试验注册
试验注册 主要研究于2019年8月10日在ClinicalTrials.gov上进行回顾性注册，识别号为NCT03624829。
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