社区老年糖尿病患者抑郁障碍现况调查

目的:调查社区老年糖尿病患者抑郁障碍的患病率及其危险因素。方法:对2015年采用多层次整群随机抽样法抽取的上海市浦东新区常住户籍≥60岁的3 579名老年居民进行调查;以《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)轴I障碍定式临床检查患者版(SCID-I/P)为诊断工具,对患有糖尿病的老人抑郁障碍患病率、抑郁障碍特点及其危险因素进行分析。结果:共有3 478位社区老年居民完成调查,525例(15.09%)符合糖尿病诊断,446例(12.82%)符合抑郁障碍诊断。糖尿病患者中100例(19.05%)共病抑郁障碍,2 953位非糖尿病老人中抑郁障碍的发生率为11.71%(346例);糖尿病组抑郁障碍检出率明显高于老年非糖尿病组(P0.05)。Logistic回归分析显示老年糖尿病患者共病抑郁障碍与年龄、有脑梗死病史及心脏病史相关。结论:社区老年糖尿病患者抑郁障碍患病率高,尤其是高龄及有心脑血管病史者。     

上海社区老人抑郁障碍患者3年随访调查

目的:调查社区老人抑郁障碍的患病率、自然转归及其危险因素。方法:对2011年采用多层次整群随机抽样法抽取的上海市浦东新区常住户籍≥60岁的3 579名老年人进行3年后随访,以《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)轴I障碍定式临床检查患者版(SCID-I/P)为诊断工具,对入组者抑郁障碍的患病率、自然转归及其危险因素进行分析。结果:共调查3 478(97.17%)人,抑郁障碍时点患病率为12.92%(446例);3年后新发病38例(1.09%),好转和痊愈26例(1.05%),病情加重21例(0.60%);女性、不良婚姻状况具更高的患病率(P均0.05);糖尿病及心脏病是抑郁障碍的易感因素(P均0.01)。结论:社区老人抑郁障碍患病率高,女性、不良婚姻状况者多见;共患糖尿病、心脏病者是易感因素。     

重性抑郁障碍与双相障碍患者躯体疾病共病调查

目的:了解重性抑郁障碍(MDD)与双相障碍(BD)患者躯体疾病共病情况。方法:对141例MDD和52例BD患者进行一般情况、躯体疾病调查及精神疾病评估。结果:MDD和BD患者躯体疾病的共病率分别为68.1%、46.2%,共病的躯体疾病以慢性病为主,依次为高血压、慢性胃炎、腰椎间盘突出、糖尿病。与非共病患者比较,共病患者年龄及起病年龄大,精神疾病复发次数多(P0.05或P0.01)。MDD共病患者自杀意念风险明显增加(P0.01)。结论:较高龄及较高龄起病的MDD、BD患者更易共病慢性躯体疾病。     

上海市浦东社区老人抑郁障碍与认知功能障碍流行病学调查

目的:了解上海原浦东地区老年抑郁障碍与认知功能障碍的患病率及二者之间的关系,为开展社区老年精神卫生工作提供科学依据. 方法:按照整群随机抽样方法,随机抽取其中60岁以上老人3 311名进行调查,抑郁障碍直接使用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)轴Ⅰ障碍定式临床检查患者版(SCID-I/P)为诊断工具,以DSM-Ⅳ为诊断标准.认知功能障碍患者轻度认知功能障碍按Petersen MCI诊断标准,Alzheimer型痴呆患者以DSM-Ⅳ为诊断标准. 结果:抑郁障碍时点患病率(632例)为19.09％,认知功能障碍时点患病率(837例)为25.28％,抑郁障碍患者的患病率与认知功能障碍、年龄、独居有明显相关性(P＜0.05);认知功能障碍患者的患病率与抑郁障碍、年龄、文化程度、独居及有无躯体情况有明显相关性(P＜0.05). 结论:上海浦东新区社区老人抑郁障碍及认知功能障碍患病率高,且二者存在关联.     

社区老人代谢综合征伴发抑郁障碍3年发展趋势流行病学调查

目的:探索社区老人抑郁障碍与代谢综合征间的发生发展关系。方法:采用分层随机抽样法,对上海浦东新区55岁的老年人进行调查,并在3年后对上述老人进行复查。以DSM-Ⅳ轴Ⅰ障碍定式临床检查患者版本为调查诊断工具,以内科诊断结果为代谢性疾病诊断依据。分析入组者抑郁障碍及代谢性疾病的患病率和易感因素。结果:调查第1年抑郁障碍发生率为16.76%,第3年为17.61%;调查第1年重症抑郁发生率为2.77%、亚临床抑郁发作2.82%、轻度抑郁发作3.99%、恶劣心境7.18%;与第3年比较均差异无统计学意义(P0.05)。调查第1年代谢综合征患病率为56.25%、其中高血压为50.41%、糖尿病14.38%及高脂血症8.34%,与第3年比较均差异无统计学意义(P0.05);代谢综合征与抑郁障碍共病率为23.72%,糖尿病与抑郁障碍共病率最高(52.32%),同时患有3种代谢性疾病者其与抑郁障碍的共病率为70.49%,明显高于患有2种、1种及无代谢性疾病者(P0.05)。结论:3年内老年人MS与抑郁障碍的发生发展趋势相对平稳。     

抑郁症与焦虑障碍共病临床特征研究

目的 调查抑郁症和焦虑症障碍的共病率,以及对临床严重程度的影响.方法 采用前瞻性、多中心、队列研究.入组对象符合美国精神障碍诊断与统计手册(第4版)抑郁症的诊断标准, 采用17项汉密尔顿抑郁量表(HAMD)和焦虑量表(HAMA),社会功能缺陷筛选量表(SSDS)和临床大体量表(CGI)评估.观察流行病学资料,焦虑和抑郁症状群、自杀状况.用情感性障碍和精神分裂症检查提纲中有关焦虑障碍的诊断清单评定患者合并的焦虑障碍.结果 共入组508例患者,首次抑郁发作为269例(53.0%),294例(57.9%)有过自杀观念,55例(10.8%)曾有自杀行为.45例(8.9%)伴精神病性症状.HAMD量表总分平均为(32.6±7.7)分;HAMA量表平均为(21.0±7.3)分,其中78.5%患者大于14分.抑郁症患者焦虑障碍的共病发生率为68.9%(350例),16.7%共病多种焦虑障碍.焦虑障碍种类分布以广泛性焦虑障碍为主,为56.1%.焦虑对抑郁症的临床严重程度有显著统计学意义,但自杀观念和自杀行为在共病与非共病之间未见统计学意义.36.0%患者同时伴有躯体疾病.结论 抑郁症与焦虑共病在临床上是常见的现象,合并的焦虑障碍以广泛性焦虑障碍为主,1/3的患者合并躯体疾病,应引起临床医生重视.     

2005年深圳市抑郁障碍患病率的现况调查

目的 了解深圳市≥18岁人群抑郁障碍的患病率和分布特点.方法 以世界卫生组织-世界精神健康联盟(WHO-WMH)提供的复合性国际诊断访谈表(CIDI3.1)为访谈工具,采用多阶段分层随机抽样方法对7134人进行面对面调查.结果 (1)加权终生患病率:为7.74%;重型抑郁、轻微抑郁和恶劣心境分别为6.19%、1.28%和0.27%;女性高于男性[8.78%∶6.75%,比值比(OR)=1.33,95%可信区间(95% CI)=1.12～1.58,P＜0.01].(2)加权12个月患病率:为3.67%,女性高于男性(3.89%∶3.01%,OR=1.30,95% CI=1.01～1.68,P＜0.05).(3)加权30 d患病率:为1.45%,女性高于男性(1.85%∶0.97%,OR=1.93,95% CI=1. 27～2.91,P＜0.01).(4)共病率:为40.14%,共病的主要类型为强迫症(15.73%)、焦虑症(14.65%)和恐惧症(13.38%).(5)患病率及病情严重程度与性别、年龄、婚姻状况、文化程度和经济状况等因素有关,年龄24～29岁和30～34岁人群的终生患病率明显高于年龄18～23岁者,同居者和独居者患病率高于已婚者,受教育年限≥13年者患病率明显高于0～6年者,家庭收入高者患病率明显高于家庭收入低者.结论 抑郁障碍已经成为深圳市人群的常见病,具有发病年龄小、共病率高和就诊率低的特点.     

儿童青少年焦虑与抑郁障碍共病的临床研究

目的了解焦虑和抑郁障碍患儿中焦虑与抑郁共病的发生率和行为特点。方法在门诊收集符合中国精神障碍分类与诊断标准第3版中焦虑障碍和抑郁障碍诊断标准的5～17岁儿童青少年,其中单纯焦虑障碍41例(焦虑组),单纯抑郁障碍31例(抑郁组),焦虑与抑郁共病31例(共病组)。由父母、儿童、医师分别采用自编一般资料表、Achenbach儿童行为量表(CBCL)、儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁障碍自评量表和儿童大体评定量表,评定三组儿童。结果(1)焦虑障碍患儿有16%(8例)合并抑郁;抑郁障碍患儿有42%(23例)合并焦虑。(2)CBCL焦虑组的活动情况及社会能力总分[(15.74±3.65)分]优于共病组[(12.98±4.00)分]和抑郁组[(14.02±3.67)分],均P<0.01和<0.05;共病组行为问题总分[(61.74±28.96)分]高于焦虑组[(43.44±22.54)分]和抑郁组[(47.74±25.99)分;F=4.62,P<0.05]。(3)SCARED共病组的总分高于焦虑组和抑郁组(P<0.05)。(4)儿童抑郁障碍自评量表抑郁组和共病组总分高于焦虑组(P<0.01)。(5)儿童大体评定量表焦虑组[(67.71±9.54)分]优于抑郁组[(58.55±8.08)分]和共病组[(61.16±7.60)分;F=11.10,P<0.001]。结论儿童焦虑、抑郁共病现象常见,共病患儿比单纯焦虑或抑郁患儿的内化性问题、外化性问题更严重,社会功能损害更明显。     

双相障碍与氧化应激损伤

双相障碍(bipolar disorder,BPD)是一种高致残率的重性精神疾病,主要表现为躁狂相与抑郁相反复间歇交替或循环发作,患病率约为1%～1.5%[1].双相障碍病因复杂,迄今不明.流行病学调查显示双相障碍与心血管疾病、肥胖和糖尿病等躯体疾病的共病率较高[2],而这些躯体疾病均可能与人体内氧化应激(oxidative stress)失衡有关,由此推测氧化应激可能参与双相障碍的发生过程.     

重性抑郁障碍与双相障碍患者的共病研究

目的:调查重性抑郁障碍(MDD)和双相障碍患者(BD)精神科共病情况。方法:采用横断面调查方法,对2011年3月至8月符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的141例重性抑郁障碍和52例双相障碍患者进行一般情况问卷及国际神经精神科简式访谈问卷(MINI)调查。结果:重性抑郁障碍组和双相障碍组精神科共病率分别为30.0%和28.8%,两组共病率差异无统计学意义(χ2=0.016,P>0.05);两组共病焦虑障碍最为常见,其共病率分别为27.0%和15.4%,差异无统计学意义(χ2=2.799,P=0.094);共病酒精依赖或物质滥用差异有统计学意义(χ2=6.405,P=0.011)。结论:重性抑郁障碍和双相障碍与其他精神科疾病存在广泛共病,尤以焦虑障碍多见。     

独居老人抑郁症状和抑郁症的调查

目的调查城市独居老人的抑郁症状和抑郁症情况。方法抽查上海市虹口区一个街道、两个居委的12岁以上常住人口共5512名，收集社会人口学资料并应用流调用抑郁量表（CES—D），对于CES—D评分在16分及以上者使用定式临床检查（SCID）进行诊断，分析60岁以上独居者的人口学、抑郁症状及抑郁症情况。结果60岁以上独居老人占调查对象的1．19％，占60岁以上老年人口的4．20％，独居老人的人口学资料和一般情况与非独居老人差异没有统计学意义。60岁以上老人的抑郁症状检出率为8．26％（118／1428），高于60岁以下者的抑郁症状检出率（4．2％）；60岁以上老人中抑郁症状检出率独居者高于非独居者（20．00％vs7．74％，χ^2=2．57，P〈0．01），抑郁症检出率独居者高于非独居者（5．0％vs0．58％,χ^2=14．66，P〈0．01）。结论城市人口老龄化程度高，老年人尤其独居者的抑郁症状及抑郁症检出率较高，应该重视独居老年人心理健康。     

Prevalence and predictors of depression in populations of elderly: a review

OBJECTIVE: To offer an update on prevalence and predictors of old age depression in populations of elderly Caucasians. METHOD: The databases MEDLINE and Psychinfo were searched and relevant literature from 1993 onwards was reviewed. RESULTS: The prevalence of major depression ranges from 0.9% to 9.4% in private households, from 14% to 42% in institutional living, and from 1% to 16% among elderly living in private households or in institutions; and clinically relevant depressive symptom 'cases' in similar settings vary between 7.2% and 49%. The main predictors of depressive disorders and depressive symptom cases are: female gender, somatic illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a history of depression. CONCLUSION: Depression is frequent in populations of elderly. Methodological differences between the studies hinder consistent conclusions about geographical and cross-cultural variations in prevalence and predictors of depression. Improved comparability will provide a basis for consistent conclusions.     

Gender differences in the prevalence of somatic versus pure depression: a replication

OBJECTIVE: Using data from the Epidemiologic Catchment Area (ECA) study, the author attempted to replicate the finding of the National Comorbidity Survey that the prevalence of depression associated with somatic symptoms was much higher among women than men. METHOD: The author reanalyzed data from the ECA study. He divided respondents into those who met criteria for major depression and exhibited appetite and sleep disturbances and fatigue (somatic depression) and those who met depression criteria but did not exhibit all of these somatic criteria (pure depression). RESULTS: The reanalysis revealed that the prevalence of somatic depression but not pure depression was much higher among women than men. Somatic depression was associated with high rates of pain; among women, it was associated with high rates of anxiety disorders and chronic dysphoria. CONCLUSIONS: The gender difference in depression may result from a difference in a specific type of depression-anxious somatic depression.     

The natural history of late-life depression: a 6-year prospective study in the community

BACKGROUND: Accurate assessment of the natural history of late-life depression requires frequent observation over time. In later life, depressive disorders fulfilling rigorous diagnostic criteria are relatively rare, while subthreshold disorders are common. The primary aim was to study the natural history of late-life depression, systematically comparing those who did with those who did not fulfill rigorous diagnostic criteria. METHODS: Within the Longitudinal Aging Study Amsterdam, a large cohort of depressed elderly persons (n = 277) was identified and followed up for 6 years, using 14 observations. Depression was measured using self-reports (the Center for Epidemiological Studies Depression Scale) and diagnostic interviews (the Diagnostic Interview Schedule). The natural history was assessed for symptom severity (Center for Epidemiological Studies Depression Scale score), symptom duration, clinical course type, and stability of diagnoses. RESULTS: The average symptom severity remained above the 85th percentile of the population average for 6 years. Symptoms were short-lived in only 14%. There were remissions in 23%, an unfavorable but fluctuating course in 44%, and a severe chronic course in 32% (percentages do not total 100 because of rounding). Comparing the outcome, there was a clear gradient in which those with subthreshold disorders had the best outcome, followed by those with major depressive disorder, dysthymic disorder, and double depression. However, the prognosis of subthreshold disorders was unfavorable in most cases, while this group was at high risk of developing DSM affective disorders. CONCLUSIONS: The natural history of late-life depression in the community is poor. DSM affective disorders are relatively rare among elderly persons, but do identify those with the worst prognosis. However, subthreshold depression is serious and chronic in many cases.     

Assessing mental health and its association with income and resource utilization in old-old Chinese in Hong Kong.

OBJECTIVES: The authors assessed mental health status and its association with income and resource utilization in old-old Chinese citizens in Hong Kong. METHODS: Stratified disproportional random sampling in 1991-92 assembled a cohort of 1,696 elderly community-dwelling subjects who were age 70 or above, measuring the age and education adjusted mean level of cognitive functioning and geriatric depression, by income groups and further investigating the association between mental health and income by incorporating deficiencies in activities of daily living (ADL) and the presence of major chronic conditions in the multivariate regressions. The association between mental health and resource utilization, including physician visits and use of medication, was examined by multivariate regression analyses. RESULTS: Better cognitive functioning was associated with higher income across groups. Lower geriatric depression was associated with higher income. Cognitive impairment was associated with the ADL deficiencies, and geriatric depression was associated with a number of major chronic conditions and higher resource utilization, including physician visits and medication use. CONCLUSIONS: Income was significantly associated with cognitive functioning and geriatric depression in elderly persons in Hong Kong. Mental health, ADL deficiency, major chronic conditions, and resource utilization are interrelated. The fact that aging in the population is associated with increasing cognitive impairment and geriatric depression presents new challenges in financing and delivering efficient and equitable health care in the region.     

Comorbidity of the anxiety disorders in a community-based older population in The Netherlands

OBJECTIVE: The aim of the study was to investigate patterns of comorbidity among the anxiety disorders in a community-based older population, and the relationship of these disorders with major depression, use of alcohol and benzodiazepines, cognitive impairment and chronic somatic illnesses. METHOD: The data were derived from the Longitudinal Aging Study Amsterdam (LASA) study. A two-stage screening design was adopted to identify respondents with anxiety disorders. RESULTS: In total, 10% of the elderly with an anxiety diagnosis suffered from two or more anxiety disorders. Major depression (13% vs. 3%), benzodiazepine use (24% vs. 11%) and chronic somatic diseases (12% vs. 7%) were significantly more prevalent in respondents with an anxiety disorder than in respondents without anxiety disorders. Heavy or excessive alcohol intake (5% vs. 4%) and cognitive impairment (11% vs. 13%) were not significantly associated with any anxiety disorder. CONCLUSION: When anxiety disorders are diagnosed, in older people there is a relatively high probability of comorbid conditions being present.     

Risk of depression in patients with chronic respiratory diseases: results from two large cohort studies in Chinese elderly from Hong Kong

OBJECTIVE: Although it has been suggested that depression is common in patients with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), few studies on the association between chronic respiratory diseases and depression have been conducted in the community. METHOD: Data from the baseline examination of two cohort studies, Mr and Ms Os, Hong Kong were used. Three thousand nine hundred and ninety-eight Hong Kong men and women aged 65 to 92 were recruited. Depression was assessed by face-to-face interview, using the short-form of a validated Chinese version of the Geriatric Depression Scale (GDS). Chronic respiratory disease was assessed by subjects' self reports of chronic respiratory disease (chronic bronchitis, emphysema and asthma) diagnosed by medical doctors. Adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CI) for depression among subjects with chronic respiratory diseases relative to those without (controls) were calculated, after adjustments were made for potential confounders. RESULTS: Chronic respiratory disease was associated with a higher prevalence of depressive disorders with an odds ratio of 1.58 (95% CI = 1.12-2.13) after adjustment was made for age, sex, cigarette smoking, alcohol drinking and history of cardiovascular diseases when compared with controls. For those subjects with self report of chronic respiratory disease and who screened positive for depression (n = 44), none were on antidepressants. Among subjects who screened positive for depression without self-report of chronic respiratory disease (n = 328), only 2.74% (n = 9) were on antidepressants. CONCLUSIONS: We conclude that chronic respiratory disease is independently associated with depression in Chinese elderly. Moreover, depression in the elderly is under-treated in those with and without chronic respiratory disease. Clinicians, especially primary care physicians in the community, should be more aware of increased prevalence of depression in patients with chronic respiratory disease.     

抑郁与焦虑共病障碍临床研究

目的:调查抑郁与焦虑共病障碍的发生率,探讨其特点及预后.方法:对150例抑郁障碍患者用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、社会功能缺陷筛选量表(SDSS)和临床疗效总评量表(CGI)评定,3个月后进行随访.结果:45.3%的抑郁障碍患者共病焦虑障碍,共病以广泛焦虑障碍与惊恐障碍为最多(分别为22.0%、13.3%);入组时及3个月末,共病组HAMD、HAMA、CGI及SDSS总分均显著高于抑郁组(P＜0.05),3个月末共病组HAMA减分率显著低于抑郁组(P＜0.05),HAMD减分率两组差异无显著性.结论:抑郁与焦虑共病障碍发生率高,具有抑郁及焦虑症状重、社会功能损害重,焦虑症状不易缓解等特征.     

Mortality and mental disorders in a Spanish elderly population

OBJECTIVE: To analyse the relationship between mental disorders and mortality rates in the elderly community of Zaragoza, Spain. METHODS: Baseline, cross-sectional study (two-stage screening) of a representative, stratified sample (N=1080) of the elderly (65+ years) living in the community. Follow-up study (4.5 years). INSTRUMENTS: Spanish versions of Geriatric Mental State, AGECAT computerized diagnostic program and Mini-Mental Status Examination. RESULTS: Two hundred and sixteen subjects died during the follow-up period (global mortality rate 4.8% per year). Using a logistic regression model with sex, age, educational level, physical illness and AGECAT diagnoses as explanatory variables and alive/dead as response, the following odds ratios (95% confidence intervals in parentheses) were obtained (reference group: non-cases): 'subcases' 1.3 (0.9-2.0), 'organic' (dementia) 3.7 (2.0-6.7), global depression 3.0 (1.7-5.3), 'psychotic' depression (melancholic type) 3.7 (1.7-8. 4), 'neurotic' depression 2.7 (1.4-5.3) and 'neuroses' 0.8 (0.2-3.6). Both pure 'organic' and pure 'depressed' cases had higher mortality when compared with comorbidity cases. CONCLUSION: There is a significant association between psychiatric morbidity and mortality in the elderly living in a Spanish community. Mortality risk in psychiatric cases are higher than previously reported in the literature.     

Gender difference in the prevalence of clinical depression: the role played by depression associated with somatic symptoms

OBJECTIVE: This study tested the hypothesis that female subjects may exhibit a higher prevalence than male subjects of depression associated with somatic symptoms but not a higher prevalence of depression not associated with these other symptoms. METHOD: The author reanalyzed research interview data on major depression from the National Comorbidity Survey, dividing respondents into those who met overall criteria for major depression and exhibited fatigue and appetite and sleep disturbance ("somatic depression") and those who met overall criteria but did not exhibit these somatic criteria ("pure depression"). RESULTS: Female subjects exhibited a higher prevalence than male subjects of somatic depression but not a higher prevalence of pure depression. Somatic depression was associated with a high prevalence of anxiety disorder and, among female subjects, with body aches and onset of depression during early adolescence. CONCLUSIONS: The gender difference in depression may result from a difference in a specific subtype of anxious somatic depression.