全球儿童青少年抑郁筛查指南综述

研究旨在了解全球儿童青少年抑郁筛查指南的研究进展，为中国儿童青少年抑郁症筛查提供参考依据。通过收集全球多个国家或机构有关儿童青少年抑郁筛查指南或专家共识，对搜集到的文献证据进行梳理后发现，目前全球多个国家与机构建议在12~18岁青少年中，基于合适的筛查工具开展青少年抑郁症的普遍性筛查，确保青少年抑郁症的早期发现、治疗及干预；针对12岁以下儿童，目前尚没有充分证据支持普遍性筛查，但建议对高风险儿童开展抑郁症筛查以期早期干预。     

儿童青少年抑郁症诊断与治疗进展

正儿童青少年抑郁症指发生在未成年时期,以显著而持续的情绪失落、兴趣缺失为主要表现的一类精神疾病,具有识别率低、治愈率低、自杀率高等特点,发病率逐年增高,严重危害我国未成年人身心健康和生命安全,但病因和发病机制迄今不明。因此,儿童青少年抑郁症的早期筛查、诊断及有效治疗具有重要意义。本篇综述基于近年来国内外相关文献及临床指南,总结儿童青少年抑郁症的筛查、诊断及临床治疗方法,为临床诊断和治疗提供参考。     

本期导读

听力损失及耳聋是全世界面临的重大公共健康问题,是全球流行最广的感觉器官残疾。随着我国健康体检广泛开展,听力筛查已经列入健康体检项目目录,现在亟需在全国健康体检中心采用统一、规范的技术标准开展听力筛查。为此,中华医学会健康管理学分会和《中华健康管理学杂志》编辑委员会组织相关学者和专家反复研讨,几易其稿,形成了《中国体检人群听力筛查专家共识》。该共识系统地介绍了听力损失的病因和危险因素,描述了体检听力筛查的方法及流程,针对不同的筛查结果给出了筛查建议。该共识为在体检人群中采用气导纯音筛查测听法稳步、有序地开展听力筛查提供了指导意见。对于早期筛查、早起诊断、及时干预治疗听力受损的患者具有重要意义。     

全球肝癌筛查指南制订现状的系统综述

目的 使用系统综述的方法对全球范围内肝癌筛查指南进行系统梳理,并根据权威机构的癌症筛查指南制订框架,对肝癌筛查制订现状进行总结和评价,从而为后续制订肝癌筛查的循证指南提供重要参考。方法 系统检索多个中英文数据库和相关网站,2019年1月3日前发布的肝癌筛查指南。根据预先制订的纳入排除标准双人独立筛选文献、提取信息。对肝癌筛查指南基本信息、筛查推荐意见、证据来源等情况进行汇总描述和总结。结果 目前国内外均无独立的肝癌筛查指南,只有17部肝癌临床实践指南（Clinical practice guidelines,CPG）中简要提到肝癌筛查推荐意见。各国肝癌CPG仅推荐对乙肝、丙肝、肝硬化等肝癌高危人群进行筛查;大部分肝癌CPG推荐筛查间隔为6个月;欧美最新指南均推荐使用超声进行筛查,而亚洲则推荐使用US和甲胎蛋白联合使用。目前肝癌CPG主要基于筛查人群患肝癌风险、筛查工具准确性、筛查成本等要素推荐相应筛查策略,尚未综合考虑筛查有效性、安全性等关键要素。结论 目前尚无独立的肝癌筛查指南,仅在肝癌CPG中描述了筛查推荐意见。目前指南仅推荐对肝癌高危人群进行筛查,筛查间隔为6个月;欧美和亚洲指南推荐的肝癌筛查措施有所差异。建议相关机构参考国际公认的其他癌症筛查指南制订的理论框架,考虑肝癌筛查的各个环节和关键要素的特殊性,制订专用的肝癌筛查循证指南。     

教育部:学生体检,都要查抑郁症

11月中旬,教育部发文,将抑郁症筛查纳入学生健康体检.同时,建立学生心理健康档案,对心理测评结果异常的学生给予重点关注. 此举引发社会关注.近年来,青少年抑郁症问题突出,已经无法再忽视. 今年3月,中国科学院发布《中国国民心理健康发展报告(2019-2020)》显示:小学阶段的抑郁检出率约一成,初中阶段约为三成,高中阶段则接近四成!     

慢性阻塞性肺疾病早期筛查及规范化诊疗项目培训会在京召开

为了使慢性阻塞性肺疾病早期筛查及规范化诊疗项目能够顺利进行，该项目的培训会2013年1月15日在中华医学会召开。会上来自首都医科大学的李星明老师详细介绍了本项目的筛查量表如何应用，并提出了哪些问题需要对体检者着重介绍与指导。来自北京6家体检中心的项目负责人针对筛查量表也提出了一些建议和意见。     

青少年抑郁症首发患者血清25-羟基维生素D3、维生素D结合蛋白水平变化及临床意义

目的 检测青少年抑郁症首发患者血清25-羟基维生素D₃[25-(OH)D₃]、维生素D结合蛋白(VDBP)水平，并分析其临床意义。方法 选取2021年4月—2022年3月秦皇岛市第一医院收治的100例青少年抑郁症首发患者为抑郁症组，并选取同期100例体检健康青少年为对照组。酶联免疫吸附法检测血清25-(OH)D₃、VDBP水平；汉密尔顿抑郁量表(HAMD)评定抑郁症患者抑郁程度，分为轻度组(n=41)、中度组(n=32)、重度组(n=27);比较抑郁症组和对照组、不同抑郁程度青少年抑郁症首发患者血清25-(OH)D₃、VDBP水平；分析青少年抑郁症首发患者血清25-(OH)D₃、VDBP水平与HAMD评分的相关性及首发青少年抑郁症发生的影响因素。结果 与对照组相比，抑郁症组患者血清25-(OH)D₃水平降低(t=10.625,P<0.05),VDBP水平升高(t=13.158,P<0.05);轻、中、重度首发青少年抑郁症患者血清25-(OH)D...     

全球针对家族史高危人群的结直肠癌筛查指南推荐意见的系统综述

目的 对全球现有结直肠癌家族史高危人群筛查指南的更新进展及推荐意见进行系统总结和评价。方法 以“结直肠癌”“筛查”“指南”“共识”“推荐”“家族史”以及“colorectal cancer”“screening”“guideline”“recommendation”“family history”为关键词,并补充其自由词,系统检索中国知网、万方数据知识服务平台、PubMed、Embase、Cochrane Library、Web of Science,并且同时检索官网刊登的结直肠癌筛查指南/共识作为补充,语种限定为中文和英文。截至2022年5月24日,共20篇有效文献。对纳入文献的基本信息、针对家族史人群的推荐意见等进行摘录整理及汇总描述。结果 在20篇文献中,大多数国家/地区/机构根据结直肠癌家族史人群的亲属关系等级,对筛查起止年龄、筛查方式及筛查周期提出建议。多数指南针对有1例60岁前患结直肠癌一级亲属的人群,推荐筛查起始年龄为40岁或比患病亲属诊断年龄提前10年,推荐的筛查方式多为结肠镜。结论 目前全球多数结直肠癌家族史高危人群筛查指南主要针对一级亲属家族史、以结肠镜作为主要筛查方式。本文将为我国针对结直肠癌家族史高危人群筛查策略的更新提供参考依据,进而完善结直肠癌筛查与早诊早治实践。     

PET-CT筛查癌症并非万能

"一次定位即可检查全身""无痛无创、安全可靠""提早筛查肿瘤……"在不少体检机构网站上,昂贵的PET-CT检查被视为实力的代表,也成了招揽顾客的招牌.普通人常规体检真的有必要做PET-CT筛查癌症吗? 发现:"查癌神器"广告号称提前半年发现病变 近期,被称为"查癌神器"的PET-CT在高端体检套餐中成为热门推荐项目.     

成都市2144名中小学生超重肥胖现状分析

分析成都市7~15岁学龄儿童青少年超重肥胖现状,为预测该地区超重肥胖发展趋势提供依据.方法 采用分层整群抽样法,共获得成都市中、小学各2所7~15岁儿童青少年有效数据2 144份.测量儿童青少年的身高、体重,计算体质量指数(BMI).分别采用中国肥胖问题工作组(WGOC)推荐的“中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准”以及国际肥胖工作组(IOTF)推荐的“儿童青少年超重肥胖筛查标准”评价超重和肥胖.结果 根据WGOC标准和IOTF标准,成都市7~15岁儿童青少年的超重率和肥胖率分别为10.68%,12.92%和6.53%,3.17%.不同性别学生超重率差异无统计学意义,男生肥胖率高于女生(P<0.05);男生超重率和肥胖率最高的年龄段分别为10~12岁和7~9岁,而女生超重率和肥胖率最高的年龄段均为10~12岁.结论 成都地区儿童青少年的肥胖问题男生较女生更为严重,且超重和肥胖出现低龄化.     

Postpartum Depression in Adolescent and Adult Mothers: Comparing Prenatal Risk Factors and Predictive Models

Our objective was to assess whether postpartum depression risk factors differ between adolescent and adult mothers and to evaluate the need for adolescent specific screening instruments. We performed a retrospective cohort study using data from the Rhode Island Pregnancy Risk Assessment Monitoring System, 2004–2008. We identified maternal age specific risk factors using weighted logistic regression and developed predictive models using a forward selected weighted logistic regression. Notable differences in odds ratios were observed for risk factors such as maternal race (OR Hispanic vs. White: 0.99, 95 % CI 0.49–1.99 among adolescents; 3.32, 95 % CI 2.01–5.49 among adults), pre-pregnancy alcohol use (OR use vs. non-use: 2.04, 95 % CI 1.08–3.86 among adolescents; 0.49, 95 % CI 0.33–0.73 among adults), and pregnancy intention (OR unintended vs. intended: 1.05, 95 % CI 0.37–2.97 among adolescents; 2.67, 95 % CI 1.51–4.74 among adults). In predictive models, adolescent postpartum depressive symptoms were most influenced by prior depression and social support while adult postpartum depressive symptoms were associated with risk factors including maternal race, pregnancy intention, SES, prior depression, mental health during pregnancy, stressors, and social support. We were able to identify similarities and dissimilarities in risk factors for postpartum depressive symptoms among adolescents and adults. Predictive models developed in the general population of pregnant women performed poorly among adolescents relative to age specific predictive models, suggesting that current screening tools may not adequately identify high risk adolescents.     

The evolving role of the primary care practitioner in adolescent depression screening and treatment

Increasing rates of depression in adolescents coupled with a decrease in the availability of psychiatric care has created the need for primary care physicians to become proficient in the screening and first-line treatment of mental and emotional disorders in their adolescent patients. This paper reviews the epidemiology and natural course of depression in adolescents, the health care climate changes leading to a decrease in the availability of psychiatric care in the community, and the role of the primary care practitioner in screening for and treating depression in the adolescent patient. In addition, screening tools and specific pharmacotherapeutic approaches are discussed.     

家庭健康促进视角下青少年抑郁的代际传递研究——基于CFPS2018的实证分析

目的：基于家庭健康促进视角,探究青少年抑郁的代际传递,为青少年心理健康促进提供理论和政策依据。方法：基于2018年CFPS数据,使用线性回归模型和Shapley值分解法分析父母抑郁水平对青少年抑郁水平的影响及其相对贡献度;利用中介和调节效应分析探讨父母日常关怀和家庭结构在抑郁代际传递中的作用机制。结果：父母抑郁水平显著影响青少年抑郁水平;亲子系统对青少年抑郁的相对贡献度最高;父母抑郁水平可通过青少年感知到的行踪关注来影响青少年抑郁水平;父母对青少年的学习和生活关怀可弱化父母抑郁对青少年抑郁的影响;与完整家庭相比,单亲家庭的抑郁代际传递效应更强。结论：青少年抑郁水平受其父母抑郁水平及所处家庭环境的影响,建议重视家庭心理健康建设,协同推进青少年心理健康促进与家庭教育形成政策合力。     

Risk factors for depression among adolescents living in group homes in South Carolina

Few data are available concerning the risk factors for depression among adolescents living in group homes. Two hundred fifty-nine adolescents ranging in age from 10 years to 20 years (median age of 15 years) residing in South Carolina group homes were interviewed for symptoms of depression and characteristics including demographics, personal history, family dynamics, academic performance, and social network. Of the study population, 47 percent are female. Population ethnicity is 64.9 percent Anglo-American and 29.1 percent African-American. Among these adolescents, 74.5 percent had clinical depression defined as a total Center for Epidemiologic Studies Depression Scale (CES-D) score of 16 or more which is much greater than population-based estimates of 0.4 to 8.3 percent. Using a total CES-D score of 23 or more, 42.9 percent of the adolescents had severe depression. Among adolescents who were clinically depressed, gender had an adjusted odds ratio (AOR) of 4.24 with a 95 percent confidence interval (CI) of 1.44 and 12.51. History of suicide attempts had an OR of 4.97 with a 95 percent CI of 1.04 and 23.75. However, among severely depressed adolescents, only gender was a significant risk factor (AOR = 6.92, 95 percent CI = 2.91, 16.42). Careful screening of all depressed adolescents in group homes for suicide attempts is indicated, especially among females, and when identified, the adolescent should receive suicide prevention counseling.     

网络成瘾和睡眠时长在青少年受校园欺凌与抑郁间的链式中介作用

目的 探索青少年网络成瘾和睡眠时长在受校园欺凌与抑郁关系之间的中介作用,为青少年抑郁的预防干预提供依据。 方法 使用青少年健康相关危险行为问卷及CES - D抑郁量表,采用多阶段整群抽样法抽取徐州市4 190名青少年进行问卷调查。结果 在控制人口学等变量后,受校园欺凌、网络成瘾、睡眠时长对抑郁均有预测作用（r = 0.283,P＜0.01;r = 0.331,P＜0.01;r = - 0.184,P＜0.01）。路径分析表明,网络成瘾在受校园欺凌和青少年抑郁之间起中介作用;网络成瘾和睡眠时长在受校园欺凌和青少年抑郁间起链式中介作用。结论 受校园欺凌不仅直接影响青少年抑郁,还通过网络成瘾和睡眠时长的链式中介作用间接影响青少年抑郁。可通过减少青少年网络使用和提高睡眠时长来降低受校园欺凌对青少年抑郁的影响。     

A qualitative study of Mexican American adolescents and depression

Depressive disorders are present in a high percentage of Mexican American adolescents. Among the US Mexican American population, suicide is the fourth leading cause of death among 10- to 19-year-olds. Little research, however, has focused on Mexican American adolescents' knowledge and views about depression and seeking help for depression. Results from a qualitative study on Mexican American adolescents' attitudes about depression are investigated in this paper. Sixty-five high school and middle school students in a largely Mexican American, urban school district in San Antonio, Tex, participated in 9 semistructured, focus group interviews where participants were asked questions to elicit their understanding of depression, treatment for depression, and words used to describe it. Coding of salient words and themes from transcribed interviews were entered into Atlas. ti for qualitative analysis. Three themes emerged: (1) adolescents' definitions of depression, (2) beliefs about adolescent depression, and (3) treatment for adolescent depression. While depressive symptoms among Mexican American adolescents are common and recognized, resource and treatment knowledge is scarce. An understanding of the beliefs, attitudes, and knowledge of these adolescents can provide crucial information about the content and structure of a universal, school-based, peer-facilitated depression awareness program.