老年抑郁的自然转归及风险预测模型  

Natural outcome and risk-prediction model of late-life depression

作　　者：刘丽婷[1] 陈树林[1] 金涛 李琳[1] 范海楠[1] 余湘娥[1] 方瑜[1] 马彦 许百华[1] 

机构地区：[1]浙江大学心理系,浙江杭州310028 [2]杭州市上城区卫生局,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2012年第6期653-658,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：美国国立卫生院资助项目(R01TW008699);中央高校基本科研业务费专项资金资助~~

摘　　要：目的:了解社区情境中老年抑郁的患病率、自然转归及风险因素预测模型。方法:随机选取一个完整社区作为研究点,采用PHQ-9量表对1275名60岁以上的老年人进行筛查;然后使用SCID,对所有PHQ-9在10分以上、50%的PHQ-9在5～9分之间的和5%的PHQ-9小于5分的老年人进行诊断性访谈,对所有接受诊断性访谈的老年人使用PHQ-9,在1年内每隔3个月随访一次,第12个月时使用SCID进行诊断访谈;把12个月之后的PHQ-9得分作为因变量,对10个可能的危险因素进行Logistic回归分析。结果:初次筛查有141人(11.1%)得分超过10分,298人(23.4%)得分为5～9分,836人(65.5%)得分为0～4分,初次诊断访谈发现符合major depressivedisorder(MDD)的老年人有93名,老年抑郁症的时点患病率是7.3%;与1年后PHQ-9得分相比,原先无抑郁症状对象中,17.6%出现抑郁症状;有抑郁症状的对象中,50%抑郁症状减少或程度下降,9%发展为明显的抑郁症状,有41%没有变化;有明显抑郁症状的对象中,12%缓解为没有明显抑郁症状,24%抑郁症状减少或程度下降,64%持续抑郁症状明显;累积疾病、社会支持、文化程度、日常能力及基线抑郁水平是其显著预测因素。结论:老年抑郁症的患病率高,1年的自然转归无明显缓解,识别率和诊断和治疗率都很低,专科-社区卫生合作的管理模型是老年抑郁防治的重要途径之一。Objective： To investigate the prevalence and natural outcome of late-life depression in the community and to analyze the risk-prediction models.Methods： A community in Hang Zhou was selected as a trial.A total of 1 275 persons aged 60 or more in this community were screened by PHQ-9 questionnaire;SCID was used for interviewer to diagnostic interview the people whose PHQ-9 was more than 10 points,50% of those whose PHQ-9 was from 5 to 9 points and 5% of those whose PHQ-9 was less than 5 points,then all those who accepted diagnostically interview were interviewed by PHQ-9 every 3 months in one year,and were diagnostic interviewed by SCID in the last month.Logistic regression analysis was used to explore depressive risk factors in 12 months.Results： There were 141（11.1%） persons whose PHQ-9 score was more than 10 points,298（23.4%） whose PHQ-9 score were 5-9 points,and 836（65.5%） whose PHQ-9 score were 0 to 4 points in the preliminary survey,93 were major depressive disorder（MDD）.The prevalence of late-life depression was 7.3%.Compared with the PHQ-9 score in one year,17.6% of those with no depressive symptoms emerged depression;50% of those who had depressive symptoms declined,9% developed to significant depressive symptoms,and 41% did not change;12% of those with significant depressive symptoms were found no depression,24% reduced,and 64% still had depression.The significant predictors were the accumulation of disease,social support,educational level,daily capacity and baseline of depression.Conclusions： The prevalence of late-life depression was high.The rates of recognition,diagnosis and treatment were low.The natural outcome after a year did not relieve apparently.Specialist-community health partnership management model is one of the important ways to prevent and treat late-life depression.

关 键 词：抑郁症 流行病学 抑郁症 病因学 风险调节 老年抑郁 社区 自然转归 预测因素 

分 类 号：R749.4[医药卫生—神经病学与精神病学]