Drossman D A, Li Z, Leserman J, Toomey T C, Hu Y J
Division of Digestive Diseases, Department of Medicine and Psychiatry, University of North Carolina, Chapel Hill, USA.
Gastroenterology. 1996 Apr;110(4):999-1007. doi: 10.1053/gast.1996.v110.pm8613034.
BACKGROUND & AIMS: Standardized assessment of health status by diagnosis (functional vs. organic) and the relative influence of abuse history on health status have not been studied previously. The aim of this study was to estimate the health status and abuse history for gastrointestinal diagnoses among patients seen in a tertiary-care gastroenterology clinic and to evaluate the relative predictive effects of diagnosis and abuse history on health status.
Standardized measures of sexual and physical abuse history and six health status measures were estimated for the patients by diagnosis. Analysis of covariance was performed to determine the relative contributions of diagnosis type and abuse history on the health status measures.
Patients with functional gastrointestinal diagnoses had poorer health status and a higher frequency of severe types of abuse than patients with structural diagnoses. Independent of abuse history, functional diagnosis was significantly associated with greater pain severity and psychological distress and poorer daily function. Independent of diagnosis, abuse history significantly contributed to greater pain severity, more days in bed, more psychological distress, and poorer daily function.
The type of diagnosis and abuse history independently contributed to the health status of this population. Therefore, medical symptoms alone may not be sufficient to understand patients' health status. Attention must also be paid to contributing psychosocial factors.
此前尚未对通过诊断（功能性与器质性）进行的健康状况标准化评估以及虐待史对健康状况的相对影响进行研究。本研究的目的是评估在一家三级医疗胃肠病诊所就诊的患者中，胃肠道诊断的健康状况和虐待史，并评估诊断和虐待史对健康状况的相对预测作用。
通过诊断对患者的性虐待和身体虐待史的标准化测量以及六项健康状况测量指标进行评估。进行协方差分析以确定诊断类型和虐待史对健康状况测量指标的相对贡献。
与结构性诊断的患者相比，功能性胃肠病诊断的患者健康状况较差，严重虐待类型的发生率更高。与虐待史无关，功能性诊断与更严重的疼痛、心理困扰以及较差的日常功能显著相关。与诊断无关，虐待史显著导致更严重的疼痛、更多的卧床天数、更多的心理困扰以及较差的日常功能。
诊断类型和虐待史独立地影响了该人群的健康状况。因此，仅依据医学症状可能不足以了解患者的健康状况。还必须关注相关的社会心理因素。
