综合医院住院患者的一项联络会诊研究
摘要
目的：调查综合医院住院患者抑郁/焦虑障碍的患病情况、病房医生对抑郁/焦虑障碍的识别现状,探索适于联络工作使用的筛查工具。
方法：以横断面研究的方法,在北京协和医院老年科病房、内分泌科1病房、消化科1病房连续纳入120例入院患者(≥14岁),使用医院焦虑抑郁量表CHADS)、综合生理心理社会健康评估量表(UPPSAQ)进行筛查并完成简明国际神经精神访谈(M.I.N.I.),同时收集上述病房患者的会诊资料。根据《美国精神障碍诊断与统计手册》第四版(DSM-IV)简明国际神经精神访谈的诊断结果,揭示综合医院住院患者抑郁/焦虑障碍的患病率并比较医院焦虑抑郁量表、综合生理心理社会健康评估量表及病房医生对抑郁/焦虑障碍进行识别的效度指标。
结果：抑郁/焦虑障碍的现患率为15.2%,病房医生对抑郁/焦虑障碍识别的灵敏度为25.0%,显著低于医院焦虑抑郁量表和综合生理心理社会健康评估量表,后者(87.5%)比前者(81.3%)的灵敏度高。
结论：综合医院住院患者抑郁/焦虑障碍患病率高于普通人群,病房医生的识别率与自评量表有差距。以评估筛查的方法推进联络工作时,综合生理心理社会健康评估量表比医院焦虑抑郁量表更敏感。
Objective:To investigate the current prevalence and clinicians'recognition rate of depressive disorder/anxiety disorders in a general hospital and to explore a screening tool apply for the work of liaison.
Methods:A cross-sectional study was conducted through consecutive sampling in inpatients of Peking Union Medical Collage Hospital during a month.120 inpatients (≥14 years-old) were recruited from department of geriatrics, department of endocrinology and department of gastroenterology. Hospital Anxiety and Depression Scale (HADS) and Union Physical Psychological Social Assessment Questionnaire (UPPSAQ) was used as screening tools for depressive and anxiety disorders, while the data of consultation has been collected. According to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Mini International Neuropsychiatric Interview (M.I.N.I.) was performed as the golden standard for diagnosing to compare the effectiveness of recognition of depressive and anxiety disorders between two self-rating scales and clinicians.
Results:The current prevalence of depressive disorder/anxiety disorders was 15.2%. Doctors'recognition rate of depressive disorder/anxiety disorders (25.0%) was lower than both HADS (81.3%) and UPPSAQ (87.5%) significantly. UPPSAQ was more sensitive than HADS.
Conclusions:The prevalence of depressive disorder/anxiety disorders in inpatients is higher than that in general population. Doctor's recognition rate was lower than self-rating scales. UPPSAQ was more sensitive than HADS as a screening tool for liaison.
方法：以横断面研究的方法,在北京协和医院老年科病房、内分泌科1病房、消化科1病房连续纳入120例入院患者(≥14岁),使用医院焦虑抑郁量表CHADS)、综合生理心理社会健康评估量表(UPPSAQ)进行筛查并完成简明国际神经精神访谈(M.I.N.I.),同时收集上述病房患者的会诊资料。根据《美国精神障碍诊断与统计手册》第四版(DSM-IV)简明国际神经精神访谈的诊断结果,揭示综合医院住院患者抑郁/焦虑障碍的患病率并比较医院焦虑抑郁量表、综合生理心理社会健康评估量表及病房医生对抑郁/焦虑障碍进行识别的效度指标。
结果：抑郁/焦虑障碍的现患率为15.2%,病房医生对抑郁/焦虑障碍识别的灵敏度为25.0%,显著低于医院焦虑抑郁量表和综合生理心理社会健康评估量表,后者(87.5%)比前者(81.3%)的灵敏度高。
结论：综合医院住院患者抑郁/焦虑障碍患病率高于普通人群,病房医生的识别率与自评量表有差距。以评估筛查的方法推进联络工作时,综合生理心理社会健康评估量表比医院焦虑抑郁量表更敏感。
Objective:To investigate the current prevalence and clinicians'recognition rate of depressive disorder/anxiety disorders in a general hospital and to explore a screening tool apply for the work of liaison.
Methods:A cross-sectional study was conducted through consecutive sampling in inpatients of Peking Union Medical Collage Hospital during a month.120 inpatients (≥14 years-old) were recruited from department of geriatrics, department of endocrinology and department of gastroenterology. Hospital Anxiety and Depression Scale (HADS) and Union Physical Psychological Social Assessment Questionnaire (UPPSAQ) was used as screening tools for depressive and anxiety disorders, while the data of consultation has been collected. According to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Mini International Neuropsychiatric Interview (M.I.N.I.) was performed as the golden standard for diagnosing to compare the effectiveness of recognition of depressive and anxiety disorders between two self-rating scales and clinicians.
Results:The current prevalence of depressive disorder/anxiety disorders was 15.2%. Doctors'recognition rate of depressive disorder/anxiety disorders (25.0%) was lower than both HADS (81.3%) and UPPSAQ (87.5%) significantly. UPPSAQ was more sensitive than HADS.
Conclusions:The prevalence of depressive disorder/anxiety disorders in inpatients is higher than that in general population. Doctor's recognition rate was lower than self-rating scales. UPPSAQ was more sensitive than HADS as a screening tool for liaison.
引文
[1]Hernandez G, Ibanez C, Kimelman M, et al. [Prevalence of psychiatric disorders in men and women hospitalized in a internal medicine service of a hospital of Santiago, Chile][J]. Rev Med Chil,2001,129(11):1279-1288.
[2]Martucci M, Balestrieri M, Bisoffi G, et al. Evaluating psychiatric morbidity in a general hospital:a two-phase epidemiological survey[J]. Psychol Med,1999,29(4):823-832.
[3]赵晓晖,洪霞,史丽丽,等.某三级甲等综合医院住院患者精神科会诊3年资料分析[J].中国心理卫生杂志,2011(01)：30-34.
[4]叶尘宇,季建林.一门边缘学科对现代医学的贡献——会诊-联络精神病学研究回顾[J].神经疾病与精神卫生,2004(02)：147-149.
[5]郭慧荣,任玉明,李幼辉.会诊联络精神病学的历史与意义[J].临床心身疾病杂志,2008,14(1)：3.
[6]Kornfeld D S. Consultation-liaison psychiatry:contributions to medical practice[J]. Am J Psychiatry,2002,159(12):1964-1972.
[7]于德华.我国会诊-联络精神病学现状及对策[J].临床精神医学杂志,2003(01)：52-53.
[8]Zigmond A S, Snaith R P. The hospital anxiety and depression scale [J]. Acta Psychiatr Scand,1983,67(6):361-370.
[9]徐俊冕,叶维菲.综合性医院焦虑抑郁量表在综合性医院病人中的应用与评价[J].中国行为医学杂志,1993,2(3)：17.
[10]郑磊磊,王也玲,李惠春.医院焦虑抑郁量表在综合性医院中的应用[J].上海精神医学,2003(05)：264-266.
[11]Bjelland I, Dahl A A, Haug T T, et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review[J]. J Psychosom Res,2002,52(2):69-77.
[12]曹锦亚.亚健康研究之二——用复合性国际诊断问卷对亚健康评估量表的验证研究[J].2009.
[13]Sheehan D V, Lecrubier Y, Sheehan K H, et al. The Mini-International Neuropsychiatric Interview (M. I.N.I.):the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10[J]. J Clin Psychiatry,1998,59 Suppl 20:22-33,34-57.
[14]Amorim P, Lecrubier Y, Weiller E, et al. DSM-IH-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI[J]. Eur Psychiatry,1998,13(1):26-34.
[15]司天梅,舒良,党卫民,等.简明国际神经精神访谈中文版的临床信效度[J].中国心理卫生杂志,2009,23(z1)：7.
[16]于德华,吴绍敏,李春波,等.综合医院住院患者焦虑与抑郁症状调查[J].临床精神医学杂志,2004(02)：68-70.
[17]季建林,叶维菲,施寿康,等.957例住院病人焦虑、抑郁障碍的研究[J].中国行为医学科学,1995(04).
[18]马辛,李淑然,向应强,等.北京市抑郁症的患病率调查[J].中华精神科杂志,2007(02)：100-103.
[19]Consortium T W W M. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys [J].2004,291.
[20]赵振环,黄悦勤,李洁,等.广州地区常住人口精神障碍的患病率调查[J].中国神经精神疾病杂志,2009,35(9)：5.
[21]姚坚,黄悦勤,阮冶,等.昆明市情感障碍流行病学调查[J].中国心理卫生杂志,2010,24(2)：6.
[22]许国勤,陈志青.512例躯体疾病患者伴发精神障碍的会诊资料分析[J].中国心理卫生杂志,2005(08).
[23]姜荣环,周沫,党卫民,等.北京市某精神病医院541例联络会诊患者的特点分析[J].中国心理卫生杂志,2009(09)：613-615.
[24]锁才跃,沈卫群,马敏麟.综合性医院内精神科会诊的回顾性分析[J].中国现代医生,2009(01)：37-38.
[25]Qin X, Phillips M R, Wang W, et al. Prevalence and rates of recognition of anxiety disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China[J]. Gen Hosp Psychiatry,2010,32(2):192-200.
[26]张艳萍,李献云,王志青,等.北京市50家综合医院门诊患者抑郁障碍的调查[J].中华精神科杂志,2006(03)：161-164.
[27]肖泽萍,严和骏,肖世富,等.综合性医院门诊病人抑郁障碍的研究[J].中华医学杂志,1999(05).
[28]中国精神卫生工作规划(2002—2010年)[J]. 上海精神医学,2003(02)：125-128.
[29]Agoub M, Moussaoui D, Kadri N. Assessment of suicidality in a Moroccan metropolitan area[J]. J Affect Disord,2006,90(2-3):223-226.
[30]牛雅娟,王志青,杨少杰,等.北京地区40家综合医院住院病人自杀意念和自杀未遂的调查[J].中国心理卫生杂志,2006(07)：457-461.
[31]季建林,赵静波.自杀预防与危机干预[Z].第一版.上海市：华东师范大学出版社,200783-84.
[2]Martucci M, Balestrieri M, Bisoffi G, et al. Evaluating psychiatric morbidity in a general hospital:a two-phase epidemiological survey[J]. Psychol Med,1999,29(4):823-832.
[3]赵晓晖,洪霞,史丽丽,等.某三级甲等综合医院住院患者精神科会诊3年资料分析[J].中国心理卫生杂志,2011(01)：30-34.
[4]叶尘宇,季建林.一门边缘学科对现代医学的贡献——会诊-联络精神病学研究回顾[J].神经疾病与精神卫生,2004(02)：147-149.
[5]郭慧荣,任玉明,李幼辉.会诊联络精神病学的历史与意义[J].临床心身疾病杂志,2008,14(1)：3.
[6]Kornfeld D S. Consultation-liaison psychiatry:contributions to medical practice[J]. Am J Psychiatry,2002,159(12):1964-1972.
[7]于德华.我国会诊-联络精神病学现状及对策[J].临床精神医学杂志,2003(01)：52-53.
[8]Zigmond A S, Snaith R P. The hospital anxiety and depression scale [J]. Acta Psychiatr Scand,1983,67(6):361-370.
[9]徐俊冕,叶维菲.综合性医院焦虑抑郁量表在综合性医院病人中的应用与评价[J].中国行为医学杂志,1993,2(3)：17.
[10]郑磊磊,王也玲,李惠春.医院焦虑抑郁量表在综合性医院中的应用[J].上海精神医学,2003(05)：264-266.
[11]Bjelland I, Dahl A A, Haug T T, et al. The validity of the Hospital Anxiety and Depression Scale. An updated literature review[J]. J Psychosom Res,2002,52(2):69-77.
[12]曹锦亚.亚健康研究之二——用复合性国际诊断问卷对亚健康评估量表的验证研究[J].2009.
[13]Sheehan D V, Lecrubier Y, Sheehan K H, et al. The Mini-International Neuropsychiatric Interview (M. I.N.I.):the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10[J]. J Clin Psychiatry,1998,59 Suppl 20:22-33,34-57.
[14]Amorim P, Lecrubier Y, Weiller E, et al. DSM-IH-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI[J]. Eur Psychiatry,1998,13(1):26-34.
[15]司天梅,舒良,党卫民,等.简明国际神经精神访谈中文版的临床信效度[J].中国心理卫生杂志,2009,23(z1)：7.
[16]于德华,吴绍敏,李春波,等.综合医院住院患者焦虑与抑郁症状调查[J].临床精神医学杂志,2004(02)：68-70.
[17]季建林,叶维菲,施寿康,等.957例住院病人焦虑、抑郁障碍的研究[J].中国行为医学科学,1995(04).
[18]马辛,李淑然,向应强,等.北京市抑郁症的患病率调查[J].中华精神科杂志,2007(02)：100-103.
[19]Consortium T W W M. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys [J].2004,291.
[20]赵振环,黄悦勤,李洁,等.广州地区常住人口精神障碍的患病率调查[J].中国神经精神疾病杂志,2009,35(9)：5.
[21]姚坚,黄悦勤,阮冶,等.昆明市情感障碍流行病学调查[J].中国心理卫生杂志,2010,24(2)：6.
[22]许国勤,陈志青.512例躯体疾病患者伴发精神障碍的会诊资料分析[J].中国心理卫生杂志,2005(08).
[23]姜荣环,周沫,党卫民,等.北京市某精神病医院541例联络会诊患者的特点分析[J].中国心理卫生杂志,2009(09)：613-615.
[24]锁才跃,沈卫群,马敏麟.综合性医院内精神科会诊的回顾性分析[J].中国现代医生,2009(01)：37-38.
[25]Qin X, Phillips M R, Wang W, et al. Prevalence and rates of recognition of anxiety disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China[J]. Gen Hosp Psychiatry,2010,32(2):192-200.
[26]张艳萍,李献云,王志青,等.北京市50家综合医院门诊患者抑郁障碍的调查[J].中华精神科杂志,2006(03)：161-164.
[27]肖泽萍,严和骏,肖世富,等.综合性医院门诊病人抑郁障碍的研究[J].中华医学杂志,1999(05).
[28]中国精神卫生工作规划(2002—2010年)[J]. 上海精神医学,2003(02)：125-128.
[29]Agoub M, Moussaoui D, Kadri N. Assessment of suicidality in a Moroccan metropolitan area[J]. J Affect Disord,2006,90(2-3):223-226.
[30]牛雅娟,王志青,杨少杰,等.北京地区40家综合医院住院病人自杀意念和自杀未遂的调查[J].中国心理卫生杂志,2006(07)：457-461.
[31]季建林,赵静波.自杀预防与危机干预[Z].第一版.上海市：华东师范大学出版社,200783-84.