Ramtin Sina, Carberry Kathleen, Correa Maria, Ring David, Alter Carol, Shanor Donna
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
Chronic Stress (Thousand Oaks). 2023 Apr 18;7:24705470231169106. doi: 10.1177/24705470231169106. eCollection 2023 Jan-Dec.
To identify differences in thoughts of suicide and symptoms of depression and anxiety by specialty among people presenting for care of physical symptoms, we analyzed data from routine mental health measurement in a small multispecialty practice and asked: 1. Are there any differences in suicidality (analyzed as an answer of 1 or greater or 2 or greater on the Patient Health Questionnaire [PHQ] question 9) in non-specialty and various types of specialty care? 2. Are there any factors-including specialty-associated with symptoms of depression (mean PHQ score), PHQ thresholds (greater than 0, 3 or greater, 10 or greater), Generalized Anxiety Disorder instrument [GAD] score of 3 or greater, and either GAD score 3 or greater or PHQ score 3 or greater? and 3. What factors are associated with referral to a social worker?
As part of routine specialty and non-specialty care, 13,211 adult patients completed a measure of symptoms of depression (PHQ) that included a question about suicidality and a measure of symptoms of anxiety (GAD). Factors associated with suicidality and symptoms of depression and anxiety at various thresholds, and visit with a social worker, were sought in multivariable models.
Accounting for potential confounding in multivariable analyses, a score higher than 0 on the suicidality question (present in 18% of people) was associated with men, younger age, English-speakers, and neurodegenerative specialty care. Symptoms of depression on their continuum and using various thresholds (28% of people had a PHQ score greater than 2) were associated with non-Spanish-speakers, younger age, women, and county insurance or Medicaid insurance. Care from the social worker was associated with PHQ score of 3 or greater and having any suicidal thoughts (score of 1 or greater on question 9) but was less common with Medicare or Commercial Insurance and less common in the unit treating cognitive decline.
The notable prevalence of symptoms of depression and suicidality among people presenting for care of physical symptoms across specialties and the relatively similar factors associated with suicidality, symptoms of depression, and symptoms of anxiety at various thresholds suggests that both non-specialty and specialty clinicians can be vigilant for opportunities for improved mental health. Increased recognition that people seeking care for physical symptoms often have mental health priorities has the potential to improve comprehensive care strategies, alleviate distress, and reduce suicide.
为了确定在因身体症状就诊的人群中，不同专科之间自杀想法以及抑郁和焦虑症状的差异，我们分析了一家小型多专科诊所常规心理健康测量的数据，并提出以下问题：1. 在非专科和各类专科护理中，自杀倾向（根据患者健康问卷[PHQ]第9题回答为1及以上或2及以上进行分析）是否存在差异？2. 是否存在与抑郁症状（PHQ平均分）、PHQ阈值（大于0、3及以上、10及以上）、广泛性焦虑障碍量表[GAD]得分3及以上，以及GAD得分3及以上或PHQ得分3及以上相关的因素，包括专科因素？3. 哪些因素与转介给社会工作者有关？
作为常规专科和非专科护理的一部分，13211名成年患者完成了一项抑郁症状测量（PHQ），其中包括一个关于自杀倾向的问题以及一项焦虑症状测量（GAD）。在多变量模型中寻找与不同阈值下的自杀倾向、抑郁和焦虑症状以及与社会工作者就诊相关的因素。
在多变量分析中考虑潜在混杂因素后，自杀倾向问题得分高于0（18%的人存在）与男性、较年轻、说英语者以及神经退行性疾病专科护理相关。抑郁症状在连续区间以及使用不同阈值（28%的人PHQ得分大于2）与非说西班牙语者、较年轻、女性以及县保险或医疗补助保险相关。由社会工作者护理与PHQ得分3及以上以及有任何自杀想法（第9题得分1及以上）相关，但在医疗保险或商业保险人群中较少见，在治疗认知功能下降的科室中也较少见。
在因身体症状就诊的各专科人群中，抑郁和自杀倾向症状的显著患病率以及与自杀倾向、抑郁症状和焦虑症状在不同阈值下相关的相对相似因素表明，非专科和专科临床医生都可以对改善心理健康的机会保持警惕。越来越认识到因身体症状就诊的人往往有心理健康方面的优先需求，这有可能改善综合护理策略、减轻痛苦并减少自杀。
