综合性医院门诊病人抑郁障碍的研究

Depressive disorders among outpatients in general hospitals

目的研究综合性医院门诊病人抑郁障碍的患病率、识别和诊治状况。方法以两步筛选法，对１５个国家或地区共２６９６９例门诊病人进行了ＧＨＤ１２、ＧＨＱ２８、复合式国际诊断检查（ＣＩＤＩ）、内科医生检查表等测定。在上海市共有５８３例完成以上量表测定，男、女比例分别为３８０％和６２０％。结果在检查出的所有心理问题中，抑郁障碍患病率居首位；总样本抑郁症和心境恶劣的患病率分别为１０４％和２１％。上海市则分别为４０％和０６％；上海市内科医生对抑郁障碍的识别率为２１％，远低于１５个国家资料的中位数５５６％；内科医生对抑郁障碍的治疗不充分，在上海市内科医生未给予检出病人任何抗抑郁剂治疗。结论在综合性医院的内科病人中，抑郁障碍是最常见的心理障碍。但抑郁障碍多未被内科医师检出且治疗不充分。内科医生的精神医学知识再教育应受到全社会的重视。

Objective To investigate the prevalence,recognition and treatment of depressive disorders among outpatients in general hospitals. Methods 26,969 outpatients of general hospitals 15 countries were interviewed by GHQ28, CIDI and physician interview scale in twostage case identification process. In Shanghai,583 patients were interviewed by all scales, among them men and women were in 38.0% and 62.0% respectively. Results Among all the psychological problems, the prevalence of depressive disorders was listed as the first one. The prevalence of major depression and dysthymia in the whole sample was 10.4% and 2.1% respectively and in Shanghai it was 4.0% and 0.6% respectively. The recognized rate of depressive disorders by physician in Shanghai was 21%, which was much lower than 55.6%the medium among the fifteen countries. The treatment of depressive disorders by physician was inadequate. None of antidepressants was prescribed by any of physician for the recognized depressive disorders in Shanghai. Conclusions Depressive disorders are the most common psychological problems in the outpatients of general hospitals, but they are underrecognized and inadequately treated in general hospitals. Reeducation of physician on mental health knowledge must be emphasized by the whole society.