Cooper-Patrick L, Crum R M, Ford D E
Division of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Med Care. 1994 Jan;32(1):15-24. doi: 10.1097/00005650-199401000-00002.
The purpose of this analysis was to compare depressed patients receiving care in the general medical setting with depressed patients receiving care in specialty mental health settings. The analysis was limited to 559 respondents from the NIMH Epidemiologic Catchment Area (ECA) study who met criteria for the diagnosis of major depression sometime in the year before the interview as defined by the Diagnostic Interview Schedule. Patients who received care in the general medical sector were more likely to be black, older than age 65, have a high school education or less, and to be women, and less likely to be in the highest socioeconomic quartile. A higher proportion of specialty mental health patients reported a lifetime history of delusions, met criteria for the diagnosis of panic disorder, obsessive-compulsive disorder, or schizophrenia, and had a lifetime history of psychiatric hospitalization. Depressed patients seen in the general medical sector had a lower chance of meeting criteria for major depression one year later than those seen in the specialty mental health sector. A multivariate analysis limited to an investigation of the relative importance of sociodemographic factors indicated that the following factors were significantly associated with receiving care in the specialty mental health care sector: age groups 31-50 and 51-65, and single marital status. Black race was inversely correlated with use of specialty mental health care. These results suggest that data generated from the specialty mental health sector can be generalized to the general medical sector only after assessing demographic differences between the two groups. Demographic differences could be associated with differences in knowledge, attitudes, interpretation of symptoms, and treatment preferences related to depression.
本分析的目的是比较在综合医疗环境中接受治疗的抑郁症患者与在专科心理健康环境中接受治疗的抑郁症患者。该分析仅限于来自美国国立精神卫生研究所流行病学集水区（ECA）研究的559名受访者，他们在访谈前一年的某个时间符合《诊断访谈时间表》所定义的重度抑郁症诊断标准。在综合医疗部门接受治疗的患者更有可能是黑人、65岁以上、具有高中及以下学历且为女性，并且处于社会经济最高四分位数的可能性较小。更高比例的专科心理健康患者报告有妄想的终生病史、符合惊恐障碍、强迫症或精神分裂症的诊断标准，并且有精神科住院的终生病史。与在专科心理健康部门接受治疗的患者相比，在综合医疗部门接受治疗的抑郁症患者一年后符合重度抑郁症标准的可能性更低。一项仅限于调查社会人口学因素相对重要性的多变量分析表明，以下因素与在专科心理健康护理部门接受治疗显著相关：31 - 50岁和51 - 65岁年龄组以及单身婚姻状况。黑人种族与专科心理健康护理的使用呈负相关。这些结果表明，只有在评估两组之间的人口统计学差异之后，才能将专科心理健康部门产生的数据推广到综合医疗部门。人口统计学差异可能与抑郁症相关的知识、态度、症状解释和治疗偏好的差异有关。
