综合医院住院患者抑郁障碍患病率调查

目的调查综合医院住院患者抑郁障碍的现患率及其在不同科室的分布情况。方法首先采用抑郁自评量表（SDS）对2007年5月在某综合医院不同科室住院的863例患者进行调查,然后对筛选有抑郁者和20％的无抑郁者采用美国《精神障碍诊断与统计手册第四版》DSM—IV轴I障碍定式临床检查（SCID—I／P）作为金标准进行抑郁障碍的诊断。结果综合医院住院患者各种抑郁障碍现患率为39．24％,重性抑郁障碍现患率为4．78％、抑郁障碍者中以女性、年龄大者、经济状况差、文化程度低、住院时间长、既往有躯体疾病史及复发情况者居多（x2=37．932,12．447,22．490,19．670,37．932,12．447,22．490,19．670;P均〈0．01）。综合医院医生识别率仅为2．88％。结论综合医院住院患者抑郁障碍患病率高;医生识别率低;女性、年龄大者、经济状况差、文化程度低、住院时间长、既往有躯体疾病史及复发者是抑郁障碍患病的高危人群。     

Prevalence and identification of alcohol use disorders among nonpsychiatric inpatients in one general hospital

Alcohol use disorders (AUDs) are common among inpatients in general hospitals and often cause excess mortality. This study investigates the prevalence of AUDs among nonpsychiatric inpatients in one general hospital and evaluates the ability of medical staff to identify such morbidity. A two-phase case-identification strategy was employed utilizing the Alcohol Use Disorders Identification Test as the first-phase screening tool and the Schedules for Clinical Assessment in Neuropsychiatry as the second-phase diagnostic interview. Among 538 eligible patients, a total of 422 (78.4%) completed the first-phase screening. A subsample (20%) of those screened negative and 90% of those screened positive were interviewed at the second phase. The weighted 1-year prevalence rates of alcohol abuse and alcohol dependence were 3.9% and 12.6%, respectively. The overall identification rate of AUDs by medical staff was 25.4% (0% for alcohol abuse and 30% for alcohol dependence). In conclusion, approximately one sixth of nonpsychiatric inpatients in a general hospital have AUDs and have been neglected substantially by medical staff. Implications of the findings for the prevention of AUDs and their physical complications are discussed.     

Prevalence and detection of alcohol use disorders among general hospital inpatients in eastern Taiwan

OBJECTIVE: To examine (1) the prevalence of alcohol use disorders (AUD) and its various correlates, and (2) the detection rate of AUD by nonpsychiatric physicians and its related factors associated with increased chances of detection among inpatients in a general hospital in rural eastern Taiwan. METHODS: A well-trained psychiatrist interviewed all adult patients admitted during a 1-month period using the Alcohol Inventory and reviewed all medical records for alcohol-related diagnoses. RESULTS: A total of 303 inpatients aged 18 to 93 years were evaluated, of whom 78 (25.7%) were diagnosed by the psychiatrist as having AUD within the past year. Males, aborigines, middle-aged, current smokers and betel quid chewers had a significantly higher odds ratio for AUD. Nonpsychiatric physicians detected only 14.1% patients with recent AUD. Internists identified AUD nearly four times as often as surgeons. Better detection was associated with higher level of alcohol intake. CONCLUSIONS: This study demonstrates the high prevalence of AUD among hospitalized patients in eastern Taiwan and the frequent failure of physicians to identify the disorder. These findings suggest that more effort should be directed toward increasing medical professionals' awareness of AUD in general hospital settings, especially among high-risk groups.     

High rates of depression anxiety and suicidal ideation among inpatients in general hospital in China

Objective: To investigate the prevalence rates of depression anxiety and suicidal ideation among Chinese general hospital inpatients and to identify the potential associations with sociodemographics.

Method: A cross-sectional survey was applied in a Chinese general hospital. A questionnaire set, including sociodemographic variables, Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7), was completed by the participants. Clinically significant depression (CSD) and clinically significant anxiety (CSA) were defined as a score above 10 on the two scales. CSD and CSA are proxy measures but not specific diagnoses of mental disorders.

Results: Data from 1329 patients were included in the final analysis. 422 (31.8%) reported clinically significant depressive symptoms, 83 (6.3%) reported frequent suicidal ideation, and 204 (15.3%) reported clinically significant anxiety. Household income was negatively associated with CSD. Inpatients with lower household incomes and educational levels had higher rates of CSA. Middle-aged inpatients were more prone to suicidal ideation, and stable marital status was related to less suicidal ideation.

Conclusion: Depression, anxiety, and suicidal ideation were determined to be common psychological problems in Chinese inpatients. Chinese medical personnel must pay attention to the mental health conditions of inpatients, particularly inpatients with lower income, educational levels, and poor marital status.

• Key Points

• This is one of the first studies focusing on the prevalence of depression and anxiety in Chinese hospitalized inpatients in non-psychiatric departments of a general hospital.

• The PHQ-9 and GAD-7 were determined to be potential screening tools to aid Chinese medical workers in recognizing depression and anxiety in nonpsychiatric departments.

• The prevalence of depression, anxiety and suicidal ideation was observed to be relatively high in inpatients, which requires more attention from Chinese clinicians.

     

Prevalence,correlates and recognition of depression among inpatients of general hospitals in Wuhan,China

ObjectiveTo determine the prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China.MethodA total of 513 patients were randomly selected from 1923 inpatients from three general hospitals and evaluated with a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I disorders by eight psychiatrists. Logistic regression was used to identify factors that were associated with depression.ResultsThe prevalence (95% confidence interval) of all current depressive disorders and major depressive disorder (MDD) was found to be 16.2% (13.0–19.4%) and 9.4% (6.8–11.9%), respectively. The correlates for depression include higher hospital class, divorce/being widowed/separation, low family income, chronic diseases, lack of medical insurance, dwelling in rural area, suffering from severe illness and multiple hospitalization history. None of the patients with current MDD were detected, treated or referred to psychiatric consultation.ConclusionsThe prevalence of depression among inpatients of general hospitals in Wuhan, China, was high. None of the depressive patients were recognized or treated for depression, indicating a serious neglect of depression in general hospitals. Our studies suggest an urgent need to improve clinicians' ability to detect and treat depression.     

Alcohol problem drinking among general hospital inpatients in northeastern Germany

OBJECTIVE: To estimate proportions of alcohol problem drinking: alcohol use disorders (AUDs) and drinking above recommended levels among general hospital inpatients in northeastern Germany. METHOD: The sample includes consecutively admitted inpatients (n=14,332) between 18 and 64 years old. This study adopted a two-stage-sampling approach including screening and ascertainment of diagnosis based on DSM-IV criteria and a quantity-frequency index. RESULTS: In total, 20.4% of all inpatients screened positive. Nine percent of the total sample were identified with current problem drinking in the following descending order: 5.3% AUD and 3.6% drinking above recommended levels. In addition, 3.1% of persons were diagnosed with alcohol dependence in remission. Proportions differed significantly among men and women (P<.001). Higher proportions of problem drinking were found at rural sites compared to urban sites (13.7% vs. 7.5%, P<.001). CONCLUSIONS: In addition to AUDs, drinking above recommended levels is a common problem among general hospital inpatients. Thus, the implementation of systematic alcohol screening and brief interventions should be considered.     

综合医院非精神科住院患者心理健康状况调查

目的 了解综合医院非精神科住院患者心理健康状况并分析其影响因素,为非精神科住院患者心理健康问题的筛查识别及构建干预模式提供参考。方法 采用横断面调查法,选取广州市某三级甲等综合医院916例非精神科住院患者为研究对象,采用患者健康问卷抑郁量表（PHQ-9）、广泛性焦虑量表（GAD-7）、阿森斯失眠量表（AIS）及哥伦比亚自杀严重程度评定量表（C-SSRS）评定住院患者的抑郁、焦虑、失眠状况和自杀风险,通过单因素分析及多因素Logistic回归分析筛选可能影响患者心理健康状况的因素。结果 共检出339例心理健康问题阳性的住院患者,阳性检出率为37.0%。心理健康各维度阳性检出情况：抑郁218例（23.8%）,焦虑141例（15.4%）,失眠257例（28.1%）,自杀意念42例（4.6%）,自杀行为7例（0.8%）。二元Logistic回归分析结果显示：女性（OR=1.379,P<0.05）是心理健康筛查阳性的危险因素。有序Logistic回归分析结果显示：年龄≥60岁（OR=1.542,P<0.05）和未婚（OR=2.055,P<0.05）是抑郁严重程度的危险因素,受教育程度为高中至大专（OR=0.524,P<0.05）是抑郁严重程度的保护因素;女性（OR=1.472,P<0.05）是失眠严重程度的危险因素。结论 综合医院非精神科住院患者的心理问题较常见,主要受性别、年龄、婚姻状况和受教育程度的影响。     

Need and utilization of psychiatric consultation services among general hospital inpatients

Objective The aim of the present study was to estimate the need for psychiatric consultation services and psychiatric inpatient referral among inpatients of non-psychiatric hospital departments, and to assess the actual utilization of these services. Methods The study was carried out among 728 inpatients of physical rehabilitation wards, medical, surgical, and gynecological wards in Austrian hospitals. Psychiatric case identification was performed by research psychiatrists using the Clinical Interview Schedule (CIS). Diagnoses were given according to DSM-III-R. The assessment of need for consultation and inpatient referral was based on the clinical judgments of research psychiatrists. Results Overall, 34.2% of the inpatients were cases according to the CIS-criteria, 51.8% of them needing either psychiatric consultation or inpatient referral according to research psychiatrists. In 66.7% of those for whom research psychiatrists had stated a need, this need was not met (“unmet need”), while only 33.3% of them had their need met. In contrast, a psychiatric consultation was performed among 5% of those patients not needing psychiatric services according to the research psychiatrists (“overprovision”). Variables of the health care system (i.e. department type and catchment area of the hospital) were among the predictors for “met needs”. Conclusion The rate of actual psychiatric consultations and admissions to psychiatric wards was markedly lower than the need according to research psychiatrists’ judgment.     

综合医院住院患者焦虑与抑郁症状调查

目的：调查综合医院中住院患者焦虑抑郁症状的时点发生比率及在不同科室病种的分布情况。方法：采用综合医院焦虑抑郁量表(HADS)，在2003年4月的同一天对综合医院的14个科室中的320例住院患者进行调查。结果：近1／3的患者出现焦虑或抑郁负性情绪；出现焦虑症状阳性者占被调查群体的35．0％，出现抑郁症状阳性者占32．2％，内科患者无论是焦虑和抑郁分，还是出现的焦虑症状和抑郁症状，均显著高于外科患者。焦虑和抑郁症状的发生与患者的年龄密切相关，即随着年龄的增大，其发生率呈增加趋势。结论：综合医院中住院患者的焦虑、抑郁反应是值得重视的现象，应处理这些负性情绪。     

Psychiatric consultation to elderly medical and surgical inpatients in a general hospital

The elderly (65 years or older) constitute approximately 25% of the patients referred for psychiatric consultations in general hospitals. The authors compared the clinical characteristics of and treatment recommendations for elderly and younger (less than 65 years) patients. Our findings revealed fourteen distinctive characteristics which differentiated the elderly from the younger patients. Most notably, the elderly have had a longer hospitalization at the time of the request for a psychiatric consultation and had a higher prevalence of organic brain syndromes (O.B.S.). Some of the implications of these results are discussed with the view to planning psychiatric services for the elderly in general hospitals.     

Prevalence of depression among Asian-Americans

The dearth of population-based studies and epidemiological investigations on the mental health problems of Asian-Americans, especially since the change in the immigration laws in 1965, has led to contradictory speculations about the prevalence rates of mental illness and the general mental health status among Asian-Americans, as opposed to other segments of the population. We administered the Center for Epidemiologic Studies Depression (CES-D) scale to 499 samples drawn from a Northwestern coastal city in order to make an initial assessment of the amount of depression experienced by Asian-Americans. The investigation compared the Asian-Americans' CES-D scores with those of whites and other minority groups, examined the scale's patterns of factor loading by ethnicity, and discovered that, even with statistical controls, there exists a distinction among the individual groups of Chinese, Filipinos, Japanese, and Koreans with respect to their score averages of depressive symptoms.     

Prevalence of metabolic syndrome among inpatients with schizophrenia

OBJECTIVE: Cardiovascular disease is one of the most prevalent factors responsible for excess mortality in schizophrenia. Metabolic syndrome (MetS) is associated with the development of coronary heart disease and diabetes mellitus. The aim in this cross-sectional study was to assess the prevalence of MetS in schizophrenic Turkish inpatients. METHOD: The study was conducted from January 2006 to June 2006, and included 231 patients with schizophrenia. All participants were enrolled from inpatients attending the Samsun Mental Health Hospital psychiatry clinic. All subjects were aged between 18 and 65 and met the DSM IV criteria for schizophrenia. MetS was taken as central obesity (defined as waist circumference: men > or = 94 cm, women > or = 80 cm) and meeting > or = 2 of the following abnormalities described by the International Diabetes Federation (IDF): a serum triglyceride level > 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL in men and < 50 mg/dL in women, blood pressure > or = 130/85 mm Hg, and a fasting serum glucose level > or = 100 mg/d/L. RESULTS: The study group consisted of 174 male and 57 female patients. Mean age was 38.5 +/- 10.5 and mean duration of illness was 15.76 +/- 9.95 years. The overall prevalence of MetS diagnosed according to the IDF criteria was 32.0% (n = 74) and was higher in females (61.4%) than in males (22.4%; p = 0.0001). In logistic regression analysis the last step of the regression model was gender (B = 1.70, p = 0.0001, OR = 5.50, 95% CI = 2.90-10.45). CONCLUSION: This study shows that the prevalence of MetS in Turkish patients with schizophrenia is similar to that of the general population, but lower than in other reports regarding the schizophrenia population.     

Prevalence of multiple personality among inpatients and outpatients

A survey of psychiatric inpatients (N = 50) and outpatients (N = 100) indicated that about 10% had multiple personality and an additional 5%-20% had amnesia for early traumatic experiences.     

Prevalence and recognition of depressive disorders in general medical inpatients

The Beck Depression Inventory (BDI) was administered to 220 of 340 patients consecutively admitted to three general medical wards of a University Hospital, whose length of hospital stay was more than five days. At least mild symptoms of depression (BDI greater than or equal to 13) were reported by 70/220 (32%) of the patients. Alternate BDI depressive patients underwent psychiatric consultation. The psychiatric consultant established a DSM-III depressive disorder in 10/33 (30%) of these patients. Only 3/10 (30%) of the DSM-III depressive patients had been referred to the consultant psychiatrist by their physician.     

Chronic pain and depression among geriatric psychiatry inpatients

OBJECTIVES: We examined whether chronic pain among depressed geriatric inpatients was associated with several clinical variables-comorbid psychiatric and medical diagnoses, length of hospitalization, suicidal ideation, and sleep duration. METHODS: Medical charts of inpatients admitted to a geriatric psychiatry unit over 2 years were examined retrospectively; 148 patients with a depressive disorder were identified. Admission pain assessments were used to classify whether patients had chronic pain. Other variables of interest were collected from charts. RESULTS: 62% of patients reported chronic pain. In multivariate regression analysis, depressed older adults with chronic pain were more likely to report suicidal ideation, be diagnosed with personality disorder, have higher medical burden, and experience decreased total sleep time compared to depressed older adults without chronic pain. CONCLUSIONS: Chronic pain--common in depressed older adults--may influence clinical features of depression and should be assessed as a possible suicide risk factor. Prospective studies should examine causal relationships and determine the effects of adequate pain treatment on depression course and suicide risk in older adults.