Lish J D, Zimmerman M, Farber N J, Lush D, Kuzma M A, Plescia G
Department of Psychiatry, Medical College of Pennsylvania, Philadelphia 19129, USA.
J Geriatr Psychiatry Neurol. 1995 Jul;8(3):141-53. doi: 10.1177/089198879500800301.
Depression in the elderly is highly prevalent, associated with functional disability and increased medical costs, and treatable; however, it is infrequently recognized and treated. The Agency for Health Care Policy and Research has advocated, therefore, increased case-finding efforts for depression in primary geriatric care. Anxiety, substance, and somatoform disorders in the elderly are similarly prevalent, associated with disability and cost, treatable, and also infrequently detected and treated. We believe that psychiatric case-finding in geriatric primary care should attend to these disorders, therefore, as well as to depression. In the present study, we examined whether the association between depressive and nondepressive forms of psychopathology was similar in geriatric and nongeriatric medical patients. We also examined the relationship between each type of pathology and health care utilization and global ratings of physical and mental health. In a VA hospital general medical outpatient clinic, 508 patients completed the SCREENER, which is a brief self-report questionnaire that screens for a range of psychiatric disorders, along with a self-report questionnaire regarding subjective health and medical care utilization. Of these patients, 98% were male, and the median age was 63 years. Patients aged 63 and over were compared to younger patients. In both geriatric and younger adult patients, we found substantial comorbidity between depressive and nondepressive forms of pathology. Moreover, in both age groups, there were significant associations between both depressive and nondepressive symptoms and fair-to-poor self-rated physical and mental health and increased medical care utilization. Approximately half of the cases of nondepressive disorders in the elderly were not comorbid with depression, and thus would not have been detected by screening for depression alone. Therefore, psychiatric case finding in primary care of geriatric males should be directed at anxiety, substance, and somatoform disorders, as well as at depression, for treatment resources to be triaged to maximally decrease morbidity and cost.
老年人抑郁症非常普遍，与功能残疾及医疗费用增加相关且可治疗；然而，它很少被识别和治疗。因此，医疗保健政策与研究机构主张在老年初级保健中加大对抑郁症的病例筛查力度。老年人中的焦虑症、物质使用障碍和躯体形式障碍同样普遍，与残疾和费用相关，可治疗，并且也很少被发现和治疗。因此，我们认为老年初级保健中的精神科病例筛查应关注这些疾病以及抑郁症。在本研究中，我们考察了老年和非老年内科患者中抑郁性与非抑郁性精神病理形式之间的关联是否相似。我们还考察了每种病理类型与医疗保健利用以及身心健康总体评分之间的关系。在一家退伍军人管理局医院的普通内科门诊，508名患者完成了SCREENER，这是一份简短的自我报告问卷，用于筛查一系列精神障碍，同时还完成了一份关于主观健康和医疗保健利用的自我报告问卷。这些患者中，98%为男性，中位年龄为63岁。将63岁及以上的患者与年轻患者进行比较。在老年和年轻成年患者中，我们都发现抑郁性与非抑郁性病理形式之间存在大量共病情况。此外，在两个年龄组中，抑郁和非抑郁症状与自评身心健康状况一般至较差以及医疗保健利用增加之间均存在显著关联。老年人中约一半的非抑郁性障碍病例未与抑郁症共病，因此仅通过筛查抑郁症是无法检测到的。因此，在老年男性初级保健中进行精神科病例筛查应针对焦虑症、物质使用障碍和躯体形式障碍以及抑郁症，以便合理分配治疗资源，最大程度降低发病率和成本。
