Katz P P, Yelin E H
Rosalind Russell Arthritis Center, Department of Medicine, University of California, San Francisco 94109.
J Rheumatol. 1993 May;20(5):790-6.
The study goals were to (1) estimate the prevalence of depressive symptoms among a community based panel of persons with rheumatoid arthritis (RA); (2) assess differences in sociodemographic characteristics of individuals with and without depressive symptoms; and (3) assess the association of depressive symptoms with clinical characteristics, function, and health services utilization.
Depressive symptoms were assessed with the Geriatric Depression Scale. Clinical characteristics examined were number of painful joints, pain rating, and self-reported health status and worsening of RA. Measures of function were the Health Assessment Questionnaire (HAQ), bed days, presence of major physical limitation, and work status. Utilization measures were RA and non-RA related physician visits and hospitalizations. Differences in sociodemographic characteristics were assessed using t tests and chi 2 tests. The association of depression with clinical, function, and utilization variables was assessed using multiple linear and logistic regression. Cross sectional analyses of data from 4 years were performed.
15-17% of persons reported depressive symptoms each year; 4% in every year. Depression in one year greatly increased the probability of depression in future years. Depressed individuals were less likely to be married, and had RA of longer duration and more comorbidities; there were no significant differences in age, ethnicity, sex, or education between the groups. Depression was associated with significantly poorer clinical characteristics and function on all variables in every year. Differences in utilization were less consistent, but generally the depressed group reported significantly more RA related physician visits and hospitalizations.
Depressive symptoms were consistently associated with negative health and functional outcomes, and, in most cases, with increased health services utilization.
本研究的目标是：（1）估计类风湿关节炎（RA）社区人群中抑郁症状的患病率；（2）评估有和没有抑郁症状的个体在社会人口学特征上的差异；（3）评估抑郁症状与临床特征、功能及卫生服务利用之间的关联。
使用老年抑郁量表评估抑郁症状。所检查的临床特征包括疼痛关节数、疼痛评分、自我报告的健康状况及类风湿关节炎的病情恶化情况。功能指标包括健康评估问卷（HAQ）、卧床天数、是否存在严重身体限制及工作状态。利用指标包括与类风湿关节炎相关和不相关的医生就诊及住院情况。使用t检验和卡方检验评估社会人口学特征的差异。使用多元线性回归和逻辑回归评估抑郁与临床、功能及利用变量之间的关联。对4年的数据进行横断面分析。
每年有15% - 17% 的人报告有抑郁症状；每年有4% 的人有抑郁症状。某一年出现抑郁会大大增加未来几年患抑郁症的可能性。抑郁个体结婚的可能性较小，患类风湿关节炎的时间更长且合并症更多；两组在年龄、种族、性别或教育程度方面无显著差异。每年抑郁与所有变量的临床特征和功能显著较差相关。利用方面的差异不太一致，但总体而言，抑郁组报告的与类风湿关节炎相关的医生就诊和住院次数显著更多。
抑郁症状始终与负面健康和功能结果相关，并且在大多数情况下，与卫生服务利用增加相关。
