抑郁症发病机制研究进展

  目的  研究抑郁症住院患者再入院情况及影响因素。  方法  根据四川省成都市2013 — 2017年参保的抑郁症住院患者的住院报销记录，分析患者入院情况，使用秩和检验和χ²检验进行差异性分析，logistic回归模型分析影响因素。  结果  本研究纳入抑郁症患者共计16 556例，25 403条住院记录。抑郁症住院患者住院率随年份增加而增加，从2013年1.92次/万人增长到2017年5.35次/万人，且女性高于男性。30 d内的再入院人数1 519例，30 d再入院率为9.17 %，5年内的再入院人数3 854例，5年再入院率则升高为23.28 %。各个时段内城乡居民医疗保险的抑郁症患者再入院率低于城镇职工医疗保险的抑郁症患者。在再入院的记录中，因为精神和行为障碍（F00-F99）再入院的人次数最多，占比28.35 %。因为循环系统疾病（I00-I99）再入院的人次数排名第2，占比20.17 %；因为呼吸系统疾病（J00-J99）再入院的人次数排名第3，占比16.27 %。logistic回归分析结果显示，女性，年龄在20 ~ 39、40 ~ 59、60 ~ 79和 ≥ 80岁，是城镇职工医疗保险参保者，住院天数在8 ~ 14、15 ~ 30和 ≥ 31 d，抑郁类别为复发性抑郁（F33）是抑郁住院患者再入院的危险因素；有其他共病，在一级、二级和三级医院就诊是抑郁住院患者再入院的保护因素。  结论  成都市抑郁住院患者再入院率较高，性别、年龄、医保类型、住院天数、抑郁类别、患病情况和医院等级是抑郁住院患者的主要影响因素。

Editorial: a systematic review of depression

  Objective  To study the status and influencing factors of readmission in depression patients.   Methods  From Chengdu Municipal Medical Insurance Administration, Sichuan province, we collected 25 043 medical and reimbursement records for 16 556 depression patients having hospitalizations during the period from 2013 through 2017; the hospitalization status of the patients was analyzed. Rank-sum test and Chi-square test were used in analysis on hospitalization-related difference among subgroups of the patients; logistic regression model was used to analyze influencing factors of some patients′ readmission.   Results  The person-times of depression patient's hospitalization for 10 000 population increased from 1.92 in 2013 to 5.35 in 2017 and the person-times was higher for female population than for male population. Among all depression patients studied, the number of readmission within 30 days of discharge was 1 519 and 30-day readmission rate was 9.17%; the total number of readmission during the 5-year period was 3 854 and the 5-year readmission rate was 23.28%. The readmission rate was lower in the patients with medical insurance for urban and rural residents than that in the patients with medical insurance for urban workers. For all the re-hospitalizations recorded, the top three diagnosis at the readmission were mental and behavioural disorders (coded with F00-F99 in International Classification of Diseases and Related Health Problems, Tenth Revision [ICD-10], accounting for 28.35% of total re-hospitalization), circulatory diseases (I00-I99, 20.17%), and respiratory diseases (J00-J99, 16.27%), respectively. Logistic regression analysis showed that female gender, aged ≥20 years, covered by medical insurance for urban workers, having the hospital stay of ≥ 8 days, and being diagnosed as recurrent depression (ICD-10 code: F33) were significant risk factors for re-hospitalization of depression patients; while, having comorbidity disease and being hospitalized in primary/secondary/tertiary hospital were significant protective factors against readmission.   Conclusion  The ratio of readmission was high among depression patients ever being hospitalized in Chengdu city and the re-hospitalization is mainly influenced by gender, age, medical insurance type, length of stay, depression type, comorbidity, and the grade of hospital providing hospitalization.