妇科门诊就诊者的抑郁症或(和)焦虑症患病率及妇科医生识别状况调查

Investigation on Incidence of Depression/Anxiety in Gynecologic Outpatients and Cognition by Gynecologists

目的调查北京地区妇科门诊就诊者抑郁症或(和)焦虑症的患病率,对照精神科医生的诊断,了解妇科医生对抑郁症和焦虑症的识别情况。方法在北京大学第一医院、北京大学人民医院、中国医学科学院协和医院的精神科医生按DSM-IV标准进行评定以确诊抑郁症或(和)焦虑症。结果(1)520例就诊者有329例(63.3%)HADS妇科门诊共计纳入520例就诊者,用焦虑抑郁量表(HADS)进行初步评估,HADS评分≥8者接受精神科医生访谈,由评分≥8分,其中263例(50.6%)接受了精神科医生访谈,并有61例(11.7%)诊断为抑郁症或(和)焦虑症;66例拒绝访谈。在考虑到拒绝访谈的人群中抑郁症或(和)焦虑症的患病率,比较接受访谈和拒绝访谈人群中HADS得分差异无统计学意义后,根据参加访谈人群的患病率对其进行校对后得出妇科门诊就诊者抑郁症患病率为11.35%,焦虑症患病率为5.58%,抑郁症或(和)焦虑症的总患病率为14.62%。(2)根据妇科医生对就诊者的处理情况来判断其是否识别出抑郁症或(和)焦虑症。妇科医生建议就诊者就诊精神科或给予精神科药物的,视为其诊断出抑郁症或(和)焦虑症。并以精神科医生的诊断为金标准来判断妇科医生是否诊断正确。在精神科医生确诊的61例抑郁症或(和)焦虑症就诊者中,妇科医生正确识别3例,灵敏度为4.9%,58例没有识别,故漏诊率为95.1%;另外有8例为妇科医生错误识别,故特异度为96.0%,误诊率为4.0%,诊断符合率为74.9%。结论妇科门诊就诊者抑郁症及焦虑症是常见的,抑郁症或(和)焦虑症的总患病率为14.62%;妇科医生对门诊就诊者抑郁症或(和)焦虑症的识别能力极低,应予以重视,妇科医生迫切需补充知识,提高对抑郁症或(和)焦虑症的识别率。

Objective To investigate the incidence of depression or/and anxiety in gynecologic outpatients in Beijing areas, to know the gynecologists＇ recognition about the depression/anxiety based on the diagnoses by psychiatrists. Methods All the 520 enrolled patients were from outpatient departments of gynecology in Peking University First Hospital, Peking University People＇ s Hospital and Peking Union Hospital. They were primarily assessed with the Hospital Anxiety and Depression Scale （HADS）. Those whose HADS score ≥ 8 were interviewed and the diagnoses of depression/anxiety were made with DSM-Ⅳ standard by psychiatrists. Results （1）There were 329 （ 63.3% ） patients whose HADS seore≥8, among them 263 （ 50.6% ） received interview by psychiatrists and 61（11.7%） were diagnosed as having depression or/and anxiety; and 66 refused interview. Based on the fact that there was no statistical difference in HADS score between the interviewees and non-interviewees, the incidence of depression/anxiety were calculated according to the incidences of the interviewees. Thus the incidence of depression, anxiety, total depression or/and anxiety was 11.35%, 5.58%, 14.62% separately. （2） According the gynecologists＇ treatments to patients, their recognized rates of depression and the anxiety were judged. If a gynecologist suggested that a patient should see a psychiatrist or prescribed psychological medicine for the patient, the doctor recognized the depression or/and anxiety, with psychiatrist＇ diagnosis being looked as the golden standard. Among all the 61 patients diagnosed by psychiatrists, 3 were correctly recognized by the gynecologists, with a sensitivity of 4.9% and a missed diagnosis rate of 95.1%. And there were 8 visitors who were mistakenly diagnosed by the gynecologists as having the disease, with a specificity of 96.0% and a misdiagnosis rate of 4.0%, and diagnosis accordance rate was 74.9%. Conclusion Depression and anxiety were common in gynecological outpatients, and the incidence of depression and or/and anxiety is 14.62%. The cognition power of the gynecologists to depression/anxiety is very low, which should be paid attention to. The basic psychiatrics training is needed for gynecologists in order to raise their cognition of depression and anxieties.