Brown C, Schulberg H C
University of Pittsburgh School of Medicine, Pennsylvania, USA.
Gen Hosp Psychiatry. 1995 Nov;17(6):414-24. doi: 10.1016/0163-8343(95)00072-0.
Depression and anxiety are the most common psychiatric disorders among ambulatory medical patients and are associated with significant functional disability. However, they remain underrecognized and/or inadequately treated. The AHCPR Depression Guideline Panel recently reviewed the efficacy of pharmacologic interventions for mood disorders in the primary care section, but there are as yet no comparable analyses of the efficacy of psychosocial interventions for primary care patients experiencing depression or anxiety. This review of randomized, controlled trials conducted in primary care settings generally supports the efficacy of psychosocial treatments (PSTs) provided to ambulatory medical patients with psychiatric disorders. However, methodologic deficiencies in these trials (i.e., diagnostic classification of study subjects, attrition patterns, and criteria for assessing treatment response) limit the generalizability of their findings to routine practice. Studies evaluating the effect of PSTs on health care cost and utilization found changes in physicians' prescribing practices, patients' use of psychotropic medication, and number of patient visits to primary care physicians. However, results varied across studies because of methodologic deficiencies similar to those noted previously. Suggestions are offered for improving the internal and external validity of randomized PST trials in primary care settings.
抑郁和焦虑是门诊患者中最常见的精神障碍，并且与严重的功能残疾相关。然而，它们仍然未得到充分认识和/或治疗不足。美国卫生保健政策与研究署（AHCPR）抑郁指南小组最近回顾了初级保健领域中药物干预对情绪障碍的疗效，但对于患有抑郁或焦虑的初级保健患者，尚未有对心理社会干预疗效的类似分析。这项对在初级保健环境中进行的随机对照试验的综述总体上支持了为患有精神障碍的门诊患者提供心理社会治疗（PSTs）的疗效。然而，这些试验中的方法学缺陷（即研究对象的诊断分类、损耗模式以及评估治疗反应的标准）限制了其研究结果在常规实践中的可推广性。评估PSTs对医疗保健成本和利用情况影响的研究发现，医生的处方习惯、患者使用精神药物的情况以及患者就诊初级保健医生的次数都有变化。然而，由于与之前提到的类似的方法学缺陷，各研究结果存在差异。文中针对提高初级保健环境中随机PST试验的内部和外部效度提出了建议。
