老年抑郁障碍患者抑郁主观体验与医师临床评估一致性的1年随访研究

Concordance between subjective experience and clinician-rated for depression severity in elderly patients with depressive disorder: 1-year follow-up study

目的:比较不同治疗阶段老年抑郁障碍患者抑郁主观体验与医师进行的临床评估的一致性,探讨其相关因素。方法:连续入组符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)诊断抑郁障碍的老年患者69例,在基线、治疗2周末、4周末及52周随访4个时间点,患者用抑郁视觉标尺(VSD)完成抑郁主观体验的自我评估,医师用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、简明精神状态检查表(MMSE)评估患者的抑郁症状、焦虑症状和认知功能评估。结果:重复测量方差分析显示,与基线相比,2周末和4周末时的VSD分[(2.7±1.6),(5.3±2.0)vs.(7.0±1.8),P<0.001]增加,HAM D分[(36±11),(17±9)vs.(9±8),P<0.001]、HAM A分下降[(27±10),(14±8)vs.(7±6),P<0.001],4周末与52周随访时的得分差异均无统计学意义(P>0.05)。基线及2周末患者VSD评分与HAMD、HAMA评分无相关性,4周末和52周时VSD与HAMD负相关(r=-0.31、-0.74,P<0.05或P<0.01)、与HAM A负相关(r=-0.36、-0.76,P<0.05或P<0.01)。Logistic回归分析显示,VSD与HAMD评分一致性与抑郁特征有关,焦虑躯体化因子得分较高的患者一致性较低(OR=0.87),而体重因子(OR=1.86)、日夜变化因子(OR=2.00)、绝望感因子(OR=1.13)得分高的患者一致性较高。结论:老年抑郁障碍患者对抑郁的主观体验与医师评估的严重程度一致性,在抑郁病情改善后相对发作期更高,提示抑郁症状特征与患者抑郁体验的自我认知有关。

Objective：To compare the concordance between subjective experience and clinician-rated in different treatment phrase of elderly patients with depressive disorder,and to explore the relevant factors.Methods：Sixty-nine consecutive elderly patients with depressive disorder diagnosed with International Classification of Diseases-10 criteria were included.The Visual Scale for Depression（VSD） were used to evaluate subjective experience of depression,while the Hamilton Depression Scale（HAMD）,Hamilton Anxiety Scale（HAMA）,Minimum Mental State Examination（MMSE） were used by clinician to evaluate depression symptom,anxiety symptom and cognition at baseline,2-,4-and 52-week of the treatment respectively.Results：Compared with baseline,VSD scores were increased at 2 weeks and 4 weeks[（2.7±1.6）,（5.3±2.0） vs.（7.0±1.8）,P〈0.001],HAMD scores were decreased at 2 weeks and 4 weeks[（36±11）,（17±9）vs.（9±8）,P〈0.001],HAMA scores were decreased at 2 weeks and 4 weeks[（27±10）,（14±8）vs.（7±6）,P〈0.001].No significant differences were found between 4 weeks and 52 weeks.There was no correlation between VSD and HAMD scores at baseline and 2 weeks.There were significant correlations among scores of VSD and HAMD（r =-0.31,-0.74,Ps 0.05）,HAMA（r =-0.36,-0.76,Ps 0.05） at 4 weeks and 52 weeks.Using logistic regression analysis,the concordance between VSD and HAMD related with the factors of HAMD,higher scores of anxiety/somatization factor were associated with lower concordance（OR = 0.87）,and higher scores of weight factor（OR = 1.86）,diurnal variation factor（OR =2.00）,hopelessness factor（OR = 1.13） were associated with higher concordance.Conclusion：Compared with acute depression phase,concordance between subjective experience and clinician-rated for depression may be higher at depression remission phase in elderly patients with depression,which suggests that characteristics of depression symptom may have a certain impact on the self-awareness for depression experience.