中国大城市肠易激综合征和功能性消化不良患者抑郁、焦虑现况研究

A cross-sectional study on the prevalence of depressive, anxiety disorder in outpatients with irritable bowel syndrome and functional dyspepsia in urban China

目的了解中国大城市消化内科肠易激综合征和功能性消化不良患者抑郁、焦虑症状患病率及既往诊治情况。方法采用现况研究方法,于2004年6月1日到9月1日在北京、广州和成都6 家综合性医院的消化内科连续收集肠易激综合征303例和功能性消化不良患者305例。由经培训的调查员用统一的调查表进行面对面调查,同时使用综合医院焦虑抑郁量表(HAD)、Hamilton焦虑量表和 Hamilton抑郁量表进行心理测评。结果肠易激综合征和功能性消化不良的抑郁、焦虑症状患病率分别为24．8％和23．6％。在具有抑郁、焦虑症状的患者中,两类患者抑郁和(或)焦虑障碍的患病率分别为69．6％和68．7％;在具有抑郁、焦虑症状的非首诊患者中,两类患者既往抑郁障碍诊断史和抗抑郁治疗的比例均低于12％,而既往焦虑障碍诊断史和抗焦虑治疗的比例则更低于8％。肠易激综合征女性患者的抑郁症状患病率显著高于男性(17．0％比8．7％;X2=4．432,P=0．035),其抑郁障碍、焦虑障碍、抑郁合并焦虑障碍以及抑郁、焦虑障碍的患病率均高于男性(52．6％比25．0％,X2=4．612,P=0．032; 79．5％比53．8％,X2=4．815,P=0．028;51．4％比21．7％,X2=5．112,P=0．024;78．6％比55．6％,X2= 4．112,P=0．043)。结论中国大城市综合医院肠易激综合征和功能性消化不良门诊患者具有较高的抑郁、焦虑症状和抑郁、焦虑障碍患病率,且既往诊治率较低,这一现状值得卫生管理部门和临床医务人员关注。

Objectives This study was to describe the prevalence of depressive and/or anxiety symptom and disorder in outpatients with irritable bowel syndrome （IBS） or functional dyspepsia （FD） in the comprehensive hospitals in big cities, China. Methods This was a hospital-based cross-sectional study conducted in three main cities in China in 2004. Six hundred and eight eligible subjects with IBS or FD were recruited consecutively from the outpatient departments within 3 months. Face-to-face interview was used in data collection together with the self-completed HAD scale for depressive and/or anxiety symptom screening. Subjects getting a HAl） score of 9 and above were further assessed for depressive and/or anxiety disorders with HAMA scales and HAMD scales by the licensed psychologists or psychiatrists. Results The prevalence of depressive and/or anxiety symptoms was 24.8% and 23.6% respectively in outpatients with IBS or FD. And among detected depressive and/or anxiety symptoms, the prevalence of depressive and/or anxiety disorder was 69.6% and 68.7% respectively; Less than 12% of subjects had obtained a diagnosis of depressive disorders and been treated, and less than 8% of subjects had obtained a diagnosis of anxiety disorders and been treated prior to the investigation. The prevalence of anxiety symptom in female patients with IBS was significantly higher than male patients （ 17.0% vs. 8.7%; χ^2 =4. 432,P=0. 035）;among detected depressive and/or anxiety symptoms, the prevalence of depressive disorder, anxiety disorder, depressive and anxiety disorder and depressive and/or anxiety disorder in female patients with IBS were higher than those in male patients （52.6 % vs. 25.0% ,χ^2 =4. 612, P=0.032;79.5%vs. 53.8%,χ^2 =4.815,P=0028;51.4%vs. 21.7% ,χ^2-5. 112,P=0.024;78.6%vs. 55.6%,χ^2 =4. 112,P=0. 043）. Conclusions It is important for healthcare providers and health policy makers to note that the prevalence of depressive and/or anxiety symptoms and depressive and/or anxiety disorders are high and the percentages of previous diagnosis and treatment in outpatients with somatic diseases in general hospitals of urban China are rather low.