中国四城市综合医院神经内科患者抑郁、焦虑现况研究

A cross-sectional study on the prevalence of depressive and/or anxiety symptoms in neurological patients from four cities in China

目的了解中国城市综合医院神经内科脑卒中、帕金森病和癫痫患者抑郁／焦虑症状现患率及既往诊治情况。方法采用现况研究方法,于2004年6月1日至9月1日在北京、上海、广州和成都的10家综合性医院神经内科连续收集脑卒中患者384例,帕金森病患者406例,癫痫患者407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。结果脑卒中、癫痫和帕金森病患者自评抑郁／焦虑症状的现患率分别为19．5％、24．1％和21．9％。在具有自评抑郁和／或焦虑症状的患者中,“明确”抑郁／焦虑症状的现患率分别为50．8％、73．1％和38．6％;在具有自评抑郁/焦虑症状的非首诊患者中,脑卒中、癫痫和帕金森病患者既往抑郁障碍诊断史和抗抑郁治疗的比例均低于17％,而既往焦虑障碍诊断史和抗焦虑治疗的比例则更低至4％。女性帕金森病患者的自评焦虑症状现患率高于男性(21．1％vs．12．2％;X2=5．679,P=0．017),其自评抑郁／焦虑症状现患率亦高于男性(30．3％vs．20．5％;X2=4．978,P=0．026);女性脑卒中患者抑郁合并焦虑症状的现患率高于男性(52．2％vs．20．0％;X2=6．009,P=0．014);女性癫痫患者抑郁症状的现患率高于男性(32．4％vs．13.6％; X2=4．108,P=0．043)。结论中国城市综合医院神经内科患者具有较高的抑郁／焦虑症状现患率,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的关注。

Objective To describe the prevalence of depressive and/or anxiety symptoms in patients with some neurological diseases in the general hospitals of major cities in China. Methods A hospital-based cross-sectional study was conducted in four big cities in China in 2004. 1197 eligible subjects with Stroke, Parkinson＇s disease and Epilepsy were recruited from the outpatient or inpatient departments within three months Face-to-face interview was used in data collection together with the self-completed Hospital Anxiety ＆ Depression （HAD） scale for depressive and/or anxiety symptom,were screened. Subjects getting a HAD score of 9 and above were further assessed for depressive and/or anxiety disorders with Hamilton anxiety scales and Hamilton depression scales by the licensed psychologists or psychiatrists. Results The prevalence rates of ＂self-scaled＂ depressive and/or anxiety symptoms were 19.5%, 24.1% and 21.9% respectively in patients with stroke, Parkinson＇s disease and epilepsy. Among cases with ＂self-scaled＂ depressive and/or anxiety symptoms, the prevalence rates of depressive and/or anxiety symptoms were 50.8 % ,73.1% and 38.6 % respectively; less than 17 % of subjects had obtained a diagnosis of depressive disorders and had been treated but only 4 % of the subjects having obtained a diagnosis of anxiety disorders and been treated prior to the study. The sex specific prevalence varied over the somatic diseases. In patients with Parkinson＇ s disease, the prevalence of ＂self-scaled＂ anxiety symptom was significantly higher in females than in males （21.1% vs. 12.2% ;x^2 5.679, P= 0.017）,and the total prevalence of ＂selfscaled＂ depressive and/or anxiety symptoms was also higher in female （30.3 % vs. 20.5 % ; x^2 = 4. 978, P =- 0. 026） ;in patients with stroke while the prevalence of depressive and anxiety symptoms in female was higher than that in male （52.2% vs. 20.0%;x^2= 6.009, P= 0.014）,and a higher prevalence of depressive symptoms in female patients with epilepsy was also reported （32.4 % vs. 13.6 % ;x^2 =4. 108,P=0.043）.Conclusion It was of great importance to remind the healthcare providers and health policy makers that high prevalence of depressive and/or anxiety symptoms was found in patients with somatic diseases but with low percentages of previous diagnosis or treatment in the departments of neurology at the general hospitals in urban China.