Zung W W, Broadhead W E, Roth M E
Department of Psychiatry, Duke University Medical Center, Durham, NC 27710.
J Fam Pract. 1993 Oct;37(4):337-44.
Depression is one of the most common medical disorders seen in primary care practice. The purpose of this study was to estimate the prevalence of depressive symptoms in primary care patients across the United States, and to describe patient characteristics that may be associated with an increased likelihood of those symptoms.
Survey data were obtained from a sample of 75,858 patients who visited one of 765 participating primary care physicians for any reason from February 1991 to September 1991. The outcome measurement used was the index score for presence of depressive symptoms on the Zung Self-rating Depression Scale.
The overall prevalence of clinically significant depressive symptoms was found to be 20.9%, but the percentage of patients citing depression as a reason for visit (1.2%) was markedly lower. Patients who perceived their health as poor were more likely to have severe depressive symptoms than patients who perceived their health as excellent. Women, those in older age groups, and those with lower levels of education were more likely to have clinically significant depressive symptoms than men, those in younger age groups, and those with higher levels of education. When classified by marital status within each sex, married men and women were the least likely to have clinically significant depressive symptoms.
Clinically significant depressive symptoms are highly prevalent in primary care patients; however, depression is an infrequent patient complaint. There are certain patient characteristics that may cue the physician to consider depression in the differential diagnosis, particularly the patient's self-perception of his or her overall health status. In addition, certain other subsets of patients are at increased risk of depression, such as women, those in older age groups, and those of lower socioeconomic status.
抑郁症是基层医疗实践中最常见的医学病症之一。本研究的目的是估计美国基层医疗患者中抑郁症状的患病率，并描述可能与这些症状发生可能性增加相关的患者特征。
调查数据来自1991年2月至1991年9月期间因任何原因就诊于765名参与研究的基层医疗医生之一的75858名患者样本。所使用的结局测量指标是zung自评抑郁量表上抑郁症状存在的指数得分。
发现具有临床意义的抑郁症状的总体患病率为20.9%，但将抑郁作为就诊原因的患者百分比（1.2%）明显较低。认为自己健康状况差的患者比认为自己健康状况极佳的患者更有可能出现严重抑郁症状。女性、年龄较大的人群以及教育程度较低的人群比男性、年龄较小的人群以及教育程度较高的人群更有可能出现具有临床意义的抑郁症状。按性别内的婚姻状况分类时，已婚男性和女性出现具有临床意义的抑郁症状的可能性最小。
具有临床意义的抑郁症状在基层医疗患者中非常普遍；然而，抑郁症是患者较少提及的主诉。有某些患者特征可能提示医生在鉴别诊断中考虑抑郁症，特别是患者对其整体健康状况的自我认知。此外，某些其他患者亚组患抑郁症的风险增加，例如女性、年龄较大的人群以及社会经济地位较低的人群。
