综合医院就诊者中焦虑障碍的检出率

Prevalence of anxiety disorders among outpatients in general hospitals

目的:了解综合性医疗机构中门诊就诊者焦虑障碍的检出率及其分布特点,为提高临床诊疗中以人为整体的诊治理念,强化非精神专科诊疗中对焦虑障碍的识别和治疗提供依据。方法:多中心横断面设计,以分别代表中国北部、东部、南部、西部和中部的5个城市(北京、上海、广州、成都和长沙),每个城市各3家,共15家三级甲等综合医院的心血管科、消化科、神经科和妇科的门诊为研究点。有8487例综合医院门诊就诊者完成调查。采用医院焦虑抑郁量表(HADS)筛查,同时完成Sheehan失能量表(SDS),记录主诉和就诊医生的诊疗意见。筛查≥8分的阳性者用简明国际神经精神访谈(MINI)作诊断评估,按DSM-IV标准做出各种焦虑障碍的诊断。诊断阳性者做抑郁自评量表(QIDS-SR16)和焦虑自评量表(SAS)评估症状严重程度。结果:经失访校正后,MINI诊断的焦虑障碍的检出率8.6%,抑郁和焦虑共病的检出率4.1%;亚型中以广泛性焦虑障碍检出率最高(4.2%)。焦虑障碍和抑郁障碍之间的共病比例(49.4%)以及焦虑障碍亚型间共病比例(56.0%)较高。有共病者的SAS和QIDS-SR16评分均高于单一焦虑诊断者(P<0.001),且SDS的3个条目分均高于单一焦虑诊断者(均P<0.05)。神经内科的焦虑障碍检出率最高(11.7%),其次是消化内科(9.4%)和心血管内科(7.8%),妇科最低(5.4%)。女性焦虑障碍的现患和终身检出率均高于男性。结论:焦虑障碍是综合医院就诊者中的常见问题,各种焦虑障碍亚型之间,以及焦虑与抑郁障碍的共病非常普遍且共病者病情更重。

Objectives： To explore the prevalence and distribution of anxiety disorders among outpatients in general hospitals. Methods： A multi-centered, hospital-based cross-sectional study was conducted in 15 tertiary gen- eral hospitals in 5 cities. A total of 8487 subjects were screened with the Hospital Anxiety Depression Scale （HAl）S）, Sheehan Disability Scale （SDS）, and the medical history review list. They were followed by regular clini- cal visit process. Physicians diagnoses and management was recorded. The Mini International Neuropsychaltric In- terview （MINI） were evaluated by psychiatrists afterwards for subjects scored ≥8 on HADS, and diagnoses of anx- iety disorders were made according to DSM-IV criteria. The self-rating of QIDS-SR16 and Zung＇s Self-rating Anxi- ety Scale （SAS） were followed by those diagnosed positive on depression or anxiety disorder. Results： The adjusted point prevalence of MINI-diagnosed anxiety disorders, and comorbid depression and anxiety were 8.6% and 4. 1%, respectively. The general anxiety disorder （GAD） was the most common （4. 2% ） among anxiety disorder spectrum. The proportion of comorbidity among anxiety disorders was high, 49. 4% with depression and 56. 0% with two or more anxiety disorders. Subjects on comorbid condition either with depression or with anxiety disorders had higher scores in QIDS-SR16 [（16. 7 ＋6.5） vs. （11.3 ±5.8）, P 〈0.001], SAS [（42.2 ±9. 3） vs. （36.7 ± 8.4）, P 〈0. 001], and in each of the three items of SDS [（5.30 ± 3.08） vs. （4. 52 ± 3.26）, （4. 37 ± 3.76） vs. （3.53 ±3.63）, （4.03 ±3, 50） vs. （2. 88 ±3.26）, P 〈0. 05] comparing to those without comorbidity. The preva- lence of anxiety disorders was different across departments with statistical significance. Neurology （11.7%） was the highest, and gynecology （5.4%） was the lowest. Females had higher current and lifetime prevalence （9. 1% and 10. 0% ） than males （7.7% and 8. 2%, P 〈 0. 05）. Conclusion： In this study, high prevalence of anxiety disor- der and comorbidity have been found among outpatients presented in general hospitals for physical problems. Those with comorbid conditions are severe on svmntoms and functionality.