综合医院非心理科病人重性抑郁发作者的特征

Characteristics of Non-psychiatric Patients with Major Depressive Episode from General Hospitals

目的了解综合医院非精神心理科门诊和住院病人中有重性抑郁发作者的抑郁和自杀特征。方法由受过培训的精神科护士采用自制抑郁筛查量表对分层、随机整群抽样的北京35家一级、8家二级和7家三级综合医院年龄≥15岁、病情允许且交流无明显困难的2877例顺序就诊的门诊病人2925例住院病人进行现况调查。结果与无重性抑郁发作的5604例病人相比,198例重性抑郁发作者中,农民(14.2%比7.9%,χ2=17.48)、自费(45.2%比37.8%,χ2=4.41)、住院(63.1%比50.0%,χ2=13.26)及内科病人所占比例高(内、外、妇产、中医和其它科病人所占比例分别为51.5%、30.8%、3.0%、2.5%和12.1%比40.7%、30.5%、9.8%、4.9%和14.0%,χ2=17.28),接受正规学校教育少[均值为(9±4)年比(10±5)年,t=-3.55],家庭人均月收入低(中位数为500元比800元,秩和检验Z=-4.86)(均P<0.05)。198例重性抑郁发作者中65%有想死的念头,50%有无望感,33%有过自杀念头,7%有过自杀行为;24%有亲友或熟人有过自杀行为;64%从未因心理问题寻求过任何帮助;11%曾因心理问题在医疗机构就诊并接受治疗,其中仅41%曾被诊断为抑郁或相关情感障碍。结论为了早期识别和治疗病人的抑郁症及有效预防自杀,应该将综合医院作为重要切入点,面向其医护人员、患者及家属大力宣传抑郁诊治及自杀预防方面的常识,同时调整其医疗管理措施以利于伴有心理障碍患者的诊治。

Objective： Describe the depressive symptoms and suicidal characteristics of patients with major depressive episodes treated in non-psychiatric outpatient and inpatient departments of general hospitals. Methods：Trained psychiatric nurses administered our depression screening instrument to 2 877 consecutive outpatients and 2 925inpatients who were at least 15 years of age, able to complete the survey and had no serious communication difficulties.These subjects were identified from 35 level-1,8 level-2, and 7 level-3 general hospitals in Beijing that were selectedby stratified random sampling. Results：Compared to 5 604 patients without depression, a higher proportion of the 198patients with major depressive episode were agricultural laborers （ 14. 2% v. 7. 9%, x^2 = 17. 48）, uninsured （45.2%v. 37.8%, x^2=4.41 ）, inpatients （63.1% v. 50. 0%, x^2 = 13.26）, treated in internal medicine departments （ theinternal medicine, surgical, genecological, traditional Chinese medicine and other medical departments distribution ofdepressed versus non-depressed patients was 51.5%, 30. 8%, 3. 0%, 2. 5%, and 12. 1% v. 40.7%, 30. 5%,9. 8%, 4. 9%, and 14. 0%, x^2=17.28 ）, less educated [ 9 （ 4 ） v. 10 （ 5 ） years of formal education, t = - 3. 55 ]and relatively poor （ median monthly per capita income in the family was 500 yuan v. 800 yuan, Z = - 4. 86 ） （ all P 〈0. 05）. Among the 198 patients with depression, 65% had thoughts of death, 50% reported hopelessness, 33% hadhad suicidal ideation, and 7% had made a suicide attempt; 24% had family members, friends or associates who hadhad suicidal behavior; 64% had never sought any type of help for psychological problems; 11% had previously received medical treatment for psychological problems but only 41% of them had been diagnosed as depressed. Conclusion： In order to recognize and treat depression as early as possible and effectively prevent suicide, general hospitalsmust become important entry-points ; extensive promulgation efforts are needed to educate the staff, patients and familymembers at these hospitals about the recognition and treatment of depression and about suicide prevention, and themethod of managing patients in hospitals needs to be made more conducive to the recognition and treatment of patientswith concurrent psychological disorders.