Linzer M, Spitzer R, Kroenke K, Williams J B, Hahn S, Brody D, deGruy F
Department of Psychiatry, Columbia University, New York, New York, USA.
Am J Med. 1996 Nov;101(5):526-33. doi: 10.1016/s0002-9343(96)00275-6.
Recently there has been increased interest in the special mental health needs of women. We used data from the PRIME-MD 1000 study to assess gender differences in the frequency of mental disorders in primary care settings, and to explore the potential impact of these differences on health-related quality of life (HRQL).
One thousand primary care patients (559 women) were interviewed during the PRIME-MD study, which was conducted at four primary care clinics affiliated with university hospitals throughout the eastern United States. Patients completed a one-page questionnaire in the waiting room prior to being seen by the physician; patients and physicians then completed together a clinician evaluation guide that used DSM-III-R algorithms to diagnose mood, anxiety, somatoform, eating, and alcohol related disorders. Health-related quality of life was assessed with the Medical Outcomes Study SF-20 General Health Survey.
Women were more likely than men to have at least one mental disorder (43% versus 33%, P < 0.05). Higher rates were particularly prominent for mood disorders (31% of women versus 19% of men, odds ratio [OR] = 1.9, 95% confidence interval [CI] 1.4 to 2.6), anxiety disorders (22% versus 13%, OR = 1.9, CI = 1.3 to 2.8), and somatoform disorders (18% versus 9%, OR = 2.2, CI = 1.5 to 3.4). Psychiatric comorbidity was also more common in women (26% of women had two or more mental disorders versus 15% of men, P < 0.05). Unadjusted HRQL scores, ranging from 0 to 100, with 100 = best health, were all significantly lower in women than in men (eg, physical function = 67 in women versus 76 in men, P < 0.0001; mental health = 69 in women versus 76 in men, P < 0.0001). Many HRQL differences persisted after controlling for age, education, ethnicity, marital status, and number of physical disorders; however, differences in HRQL were eliminated in 5 of 6 domains after controlling for number of mental disorders. When compared with female patients of male physicians, female patients of female physicians demonstrated similar satisfaction with care, health care utilization, HRQL, and recognition rate of mental disorders.
In the 1,000 patients of the PRIME-MD study, mood, anxiety, and somatoform disorders and psychiatric comorbidity were all significantly more common in women than men. The HRQL scores were poorer in women than men, although most of this difference was accounted for by the difference in prevalence of mental disorders. These data suggest that one of the most important aspects of a primary care physician's care of female patients is to screen for and treat common mental disorders.
最近，人们对女性特殊的心理健康需求越来越感兴趣。我们使用来自PRIME-MD 1000研究的数据，评估初级保健机构中精神障碍发生频率的性别差异，并探讨这些差异对健康相关生活质量（HRQL）的潜在影响。
在PRIME-MD研究期间，对1000名初级保健患者（559名女性）进行了访谈，该研究在美国东部各地大学医院附属的四家初级保健诊所进行。患者在候诊室等待就诊前填写了一份单页问卷；然后患者和医生共同完成一份临床医生评估指南，该指南使用DSM-III-R算法诊断情绪、焦虑、躯体形式、饮食和酒精相关障碍。使用医学结果研究SF-20一般健康调查评估健康相关生活质量。
女性比男性更有可能至少患有一种精神障碍（43%对33%，P<0.05）。情绪障碍（女性为31%，男性为19%，优势比[OR]=1.9，95%置信区间[CI]1.4至2.6）、焦虑障碍（22%对13%，OR=1.9，CI=1.3至2.8）和躯体形式障碍（18%对9%，OR=2.2，CI=1.5至3.4）的发生率尤其高。女性的精神共病也更常见（26%的女性患有两种或更多精神障碍，而男性为15%，P<0.05）。未调整的HRQL评分范围为0至100，100表示最佳健康状态，女性的评分均显著低于男性（例如，身体功能：女性为67分，男性为76分，P<0.0001；心理健康：女性为69分，男性为76分，P<0.0001）。在控制了年龄、教育程度、种族、婚姻状况和躯体疾病数量后，许多HRQL差异仍然存在；然而，在控制了精神障碍数量后，6个领域中的5个领域的HRQL差异消失了。与男医生的女性患者相比，女医生的女性患者在护理满意度、医疗保健利用率、HRQL和精神障碍识别率方面表现相似。
在PRIME-MD研究的1000名患者中，情绪、焦虑和躯体形式障碍以及精神共病在女性中比男性更为常见。女性的HRQL评分比男性差，尽管这种差异大部分是由精神障碍患病率的差异造成的。这些数据表明，初级保健医生对女性患者护理的最重要方面之一是筛查和治疗常见的精神障碍。
