综合医院就诊者中焦虑障碍的检出率

目的:了解综合性医疗机构中门诊就诊者焦虑障碍的检出率及其分布特点,为提高临床诊疗中以人为整体的诊治理念,强化非精神专科诊疗中对焦虑障碍的识别和治疗提供依据。方法:多中心横断面设计,以分别代表中国北部、东部、南部、西部和中部的5个城市(北京、上海、广州、成都和长沙),每个城市各3家,共15家三级甲等综合医院的心血管科、消化科、神经科和妇科的门诊为研究点。有8487例综合医院门诊就诊者完成调查。采用医院焦虑抑郁量表(HADS)筛查,同时完成Sheehan失能量表(SDS),记录主诉和就诊医生的诊疗意见。筛查≥8分的阳性者用简明国际神经精神访谈(MINI)作诊断评估,按DSM-IV标准做出各种焦虑障碍的诊断。诊断阳性者做抑郁自评量表(QIDS-SR16)和焦虑自评量表(SAS)评估症状严重程度。结果:经失访校正后,MINI诊断的焦虑障碍的检出率8.6%,抑郁和焦虑共病的检出率4.1%;亚型中以广泛性焦虑障碍检出率最高(4.2%)。焦虑障碍和抑郁障碍之间的共病比例(49.4%)以及焦虑障碍亚型间共病比例(56.0%)较高。有共病者的SAS和QIDS-SR16评分均高于单一焦虑诊断者(P0.001),且SDS的3个条目分均高于单一焦虑诊断者(均P0.05)。神经内科的焦虑障碍检出率最高(11.7%),其次是消化内科(9.4%)和心血管内科(7.8%),妇科最低(5.4%)。女性焦虑障碍的现患和终身检出率均高于男性。结论:焦虑障碍是综合医院就诊者中的常见问题,各种焦虑障碍亚型之间,以及焦虑与抑郁障碍的共病非常普遍且共病者病情更重。

Prevalence of anxiety disorders among outpatients in general hospitals

Objectives:To explore the prevalence and distribution of anxiety disorders among outpatients in general hospitals.Methods:A multi-centered,hospital-based cross-sectional study was conducted in 15 tertiary general hospitals in 5 cities.A total of 8487 subjects were screened with the Hospital Anxiety Depression Scale(HADS),Sheehan Disability Scale(SDS),and the medical history review list.They were followed by regular clinical visit process.Physician’s diagnoses and management was recorded.The Mini International Neuropsychaitric Interview(MINI) were evaluated by psychiatrists afterwards for subjects scored ≥8 on HADS,and diagnoses of anxiety disorders were made according to DSM-IV criteria.The self-rating of QIDS-SR16 and Zung’ s Self-rating Anxiety Scale(SAS) were followed by those diagnosed positive on depression or anxiety disorder.Results:The adjusted point prevalence of MINI-diagnosed anxiety disorders,and comorbid depression and anxiety were 8.6% and 4.1%,respectively.The general anxiety disorder(GAD) was the most common(4.2%) among anxiety disorder spectrum.The proportion of comorbidity among anxiety disorders was high,49.4% with depression and 56.0% with two or more anxiety disorders.Subjects on comorbid condition either with depression or with anxiety disorders had higher scores in QIDS-SR16 (16.7±6.5) vs.(11.3±5.8),P<0.001],SAS (42.2±9.3) vs.(36.7±8.4),P<0.001],and in each of the three items of SDS (5.30±3.08) vs.(4.52±3.26),(4.37±3.76) vs.(3.53±3.63),(4.03±3.50) vs.(2.88±3.26),P<0.05] comparing to those without comorbidity.The prevalence of anxiety disorders was different across departments with statistical significance.Neurology(11.7%) was the highest,and gynecology(5.4%) was the lowest.Females had higher current and lifetime prevalence(9.1% and 10.0%) than males(7.7% and 8.2%,P<0.05).Conclusion:In this study,high prevalence of anxiety disorder and comorbidity have been found among outpatients presented in general hospitals for physical problems.Those with comorbid conditions are severe on symptoms and functionality.