抑郁症患者的首次就诊模式选择及临床特点研究

Choice of First-visit Modes of Patients with Depressive Disorders and Its Clinical Characteristics

目的探讨抑郁症患者首次就诊模式的选择及临床特点。方法选择2011年1—12月就诊于我科门诊或住院的确诊为抑郁症的患者160例,对每位确诊的抑郁症患者进行深入访谈,并采用汉密尔顿抑郁量表(HAMD)进行评分。将160例患者根据发病至就诊的时间分为两组,及时就诊组62例:发病≤3个月到精神科就诊;非及时就诊组98例:发病>3个月到精神科就诊。结果两组患者的年龄、受教育程度、婚姻状况、就诊意愿、病耻感、家族史、既往史、首次就诊医院等方面差异均有统计学意义(P<0.05)。首诊综合医院的107例患者,以躯体症状为第一主诉者占86.9%;而首诊精神专科医院的53例患者,以躯体症状为第一主诉者占22.3%。首诊综合医院的107例患者HAMD评分为(21.4±4.8)分,首诊精神专科医院的53例患者HAMD评分为(23.2±5.1)分,两组间差异有统计学意义(P<0.05)。首诊于不同医院的患者对疾病的认知情况比较,差异有统计学意义(P<0.05);对抑郁诊断的接受率比较,差异亦有统计学意义(P<0.05)。结论抑郁症患者多首诊于非精神科,健康知识、躯体症状、受教育程度、婚姻状况、病耻感、家族史、躯体症状、居住地、既往史等是影响患者就诊模式的主要因素。

Objectives To explore the choice of first-visit modes of patients with depressive disorders and its clinical characteristics.Methods An interview was performed in 160 depressive disorder patients visiting or admitted to our department from January to December of 2011.Hamilton Depression Rating Scale（HAMD） was used to score.Patients were divided,according to the time from onset to visit,into groups A（n=62,seeing doctors ≤3 months after onset） and B（n=98,seeing doctors 〉3 months）.Results There was significant difference in age,educational level,marital status,intentions for seeking services,stigma,family history,past history,first-visiting hospital between two groups（P〈0.05）.A total of 107 patients first chose general hospitals（HAMD score was（21.4±4.8））,86.9% taking physical symptom as first complaint,and 53 chose psychiatric hospitals（HAMD score was（23.2±5.1））,22.3% taking physical symptoms as first complaint,the difference was significant（P〈0.05）.There was significant difference between two groups in disease recognition（P〈0.05）,and in acceptance rate of depression diagnoses（P〈0.05）.Conclusions Most of depressive disorder patients first choose non-psychiatric hospitals.Health knowledge,physical symptoms,educational level,marital status,stigma,family history,place of residence,past history are the main factors influencing the visiting modes of patients.