宁波市城市社区老年抑郁影响因素病例对照研究

目的探讨沿海城市社区老年人抑郁症状发生的影响因素。方法在现况调查的基础上,对宁波市城市社区84例中重度老年抑郁症患者和252例无抑郁症的老年人进行1∶3配比的病例对照研究,自编调查表收集可能的危险因素,并行老年抑郁量表(GDS)、社会支持评定量表(SSRS)等评定,抑郁症的诊断以两名精神科医生联合诊断为准。采用t检验、条件Logistic回归等方法进行数据分析。结果单因素分析显示,社会保障、居住模式、兴趣爱好、体育锻炼、负性生活事件、躯体疾病等因素在病例组和对照组之间差异有统计学意义(P<0.05);多因素分析证实去除了年龄、性别、居住地的影响后,负性生活事件、社会支持、生理功能、经济收入、体育锻炼及丧偶仍合并慢些性疾病与老年抑郁症状的发生显著相关,OR值(95%CI)分别为19.347(5.386～61.442),6.821(2.457～19.862),5.546(1.875～18.965),3.892(1.753～16.973),3.642(1.674～12.863),3.272(1.443～11.474),3.127(1.135～11.057)。结论负性生活事件、社会支持差、生理功能差、经济收入低、不参...     

宁波市农村社区老年抑郁危险因素的病例对照研究

目的:探讨沿海农村社区老年人抑郁症状发生的可能危险因素.方法:在现况调查的基础上,对宁波市农村社区84例有中重度老年抑郁症状和168例社区健康老人进行病例对照研究,采用卡方检验、Logistic回归等方法进行数据分析.结果:单因素分析结果显示,社会保障、居住模式、兴趣爱好、体育锻炼、负性生活事件、躯体疾病等因素在病例组和对照组之间差异有统计学意义(P≤0.05);多因素分析显示:负性生活事件、社会支持差、经济收入低、缺乏体育锻炼、患有慢性病与老年抑郁症状的发生有关,OR值(95％CI)分别为18.735(5.231～60.236),6.120 (2.347～19.352),3.883(1.743～16.964),3.633 (1.672～12.783),3.268(1.435～11.472).结论:负性生活事件、社会支持差、经济收入低、不参加体育锻炼、合并慢性病为宁波市农村社区老年抑郁症状发生的重要危险因素.     

老年期抑郁症与非老年期抑郁症临床对照分析

目的探讨老年期抑郁症的临床特点。方法对本院住院的首次发病于老年期的58例单相抑郁症患者，并与同期住院60例非老年单相抑郁患者进行对照分析。采用HAMD量表评定。结果老年期抑郁症患者，女性多于男性，病前有明显诱因，躯体不适、焦虑激越多见，精神运动迟滞，生物节律症状改变少见，阳性家族史少，治疗预后差。结论老年期抑郁症症状不够典型，有其独特的临床特点。     

米氮平合并利培酮治疗伴精神病性症状抑郁症的临床疗效观察

目的探讨米氮平配合小量利培酮治疗伴有精神病性症状的抑郁症临床效果。方法将48例患者随机分为治疗组和对照组，分别采用米氮平配合小量利培酮及单用米氮平治疗伴有精神病性症状的抑郁症，疗程共8周，治疗前及治疗1、2、4、8周末采用汉密尔顿抑郁量表HAMD进行评定，并根据HAMD量表减分率评定疗效。结果治疗后两组有效率比较差异具有统计学意义（P〈0．01）。结论米氮平配合小量利培酮治疗伴有精神病性症状的抑郁症临床疗效较好。     

联合小剂量米氮平治疗抑郁症的增效作用

目的：探讨小剂量米氮平联合舍曲林治疗“复发性抑郁症,目前为无精神病性症状的抑郁”增效作用。方法将30例无精神病性症状抑郁症患者随机分为舍曲林组和舍曲林联合小剂量米氮平组,治疗4周。于治疗前、治疗2、4周末分别应用抑郁量表（HAMD）评定疗效。结果联合小剂量米氮平组疗效显著好于单用舍曲林组。联合组治疗各周HAMD评分下降指数比单用组更为明显。结论联合小剂量米氮平治疗抑郁症可提高疗效,且改善睡眠。     

老年抑郁症的相关因素探讨

目的：探讨老年抑郁症患者的临床特点及发病影响因素。方法将我院收治的135例抑郁症患者作为研究对象,按照年龄将135例患者分为老年组和青年组,观察两组临床表现、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)评分,单独观察老年组患者性别、经济状况及身心状况与抑郁症发生率的相关性。结果老年组患者临床表现中激越行为、自杀意念行为、记忆力减退、言语动作减少及精力减退明显高于青年组,两组间差异有统计学意义(P<0.05)。老年组HAMD量表评分与青年组无差异(P>0.05),而HAMA量表评分明显高于青年组(P<0.05)。老年组患者中经济状况差、有慢性疾病及生活自理障碍者抑郁症发病率明显较高,组内比较差异有统计学意义(P<0.05)。结论老年抑郁症患者躯体症状具有典型性,并兼有明显焦虑症状,而且老年抑郁症发病率与经济状况、慢性疾病及生活自理能力有显著相关性,因此临床预防应从以上几方面介入综合干预措施。     

“心境-促进协作医疗”模式对社区老年抑郁症的疗效评价

[目的]探讨"心境-促进协作医疗"(IMPACT)管理模式对社区老年抑郁症患者疗效的影响。[方法]在上海市浦东新区精神卫生网络系统中,抽取符合病例要求的60例社区老年抑郁症患者,分为干预组和对照组,每组30例,干预组实施为期18个月的IMPACT管理治疗,对照组为常规的社区精神病康复管理。使用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和自知力与治疗态度问卷(ITAQ)评价两组干预前与干预后第6、12、18个月时的抑郁症状及服药依从性得分变化情况,比较两组患者在干预期间的复发住院率。使用生活质量表(SF-36)评价干预前、后(第18个月)两组患者的生存质量得分变化情况。[结果]在干预后第6、12、18个月,干预组患者的HAMD和SDS得分改善情况优于对照组(P均0.05),ITAQ得分提升高于对照组(P0.05)。SF-36评价中,干预组患者的躯体疼痛、一般健康状况、精力、社会功能、精神健康及健康变化得分提升均优于对照组,两组差异有统计学意义(P均0.05)。干预组无1例复发住院,对照组有6例复发住院,复发住院率为20%(χ2=6.67,P0.05)。[结论]IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,降低复发住院率,改善老年抑郁症患者的生活质量。     

保定地区社区老年人抑郁状况及其影响因素分析

目的探讨社区老年人群的抑郁现状及其影响因素。方法从保定市159个社区中采用随机整群抽样的方法抽取1个社区。应用老年人抑郁评价量表(GDS-15)和一般情况调查表、日常生活调查表、躯体状态调查表、生存质量简表(WHOQOL-100)、社会支持量表对社区内≥60岁老年人555人进行抑郁状况、日常活动能力情况、生活质量、社会支持状况等内容的调查,并进行单因素及多因素分析。结果 555例老年人中,有抑郁症状者为53例,抑郁的患病率为9.6%。非条件Logistic回归分析表明,日常活动能力差、听力障碍、需要照顾、生活质量差、社会支持少是抑郁发生的危险因素。结论保定地区老年人抑郁症状的发生主要与躯体状况、社会心理因素相关,应加强对老年抑郁的预防。     

西酞普兰联用小剂量阿立哌唑治疗伴精神病性症状抑郁症疗效观察

目的：探讨西酞普兰联用小剂量阿立哌唑治疗伴有精神病性症状抑郁症临床疗效;方法：将60例患者随机分为治疗组和对照组,分别采用西酞普兰联用小量阿立哌唑及单用西酞普兰治疗伴有精神病性症状的抑郁症,疗程共8周。治疗前及治疗1、2、4、8周末采用汉密顿抑郁量表HAMD进行评定,并根据HAMD量表减分率评定疗效。结果：治疗后两组显效率具有显著性差异（P〈0．01）。结论：西酞普兰联用小剂量阿立哌唑治疗伴有精神病性症状的抑郁症临床疗效肯定,副反应轻,临床可以推广应用。     

盐酸舍曲林和阿米替林治疗老年抑郁症患者认知功能的疗效比较

目的 对盐酸舍曲林和阿米替林治疗老年抑郁症患者认知功能、抑郁症状的疗效及不良反应进行比较.方法 将45例老年抑郁症患者随机分为盐酸舍曲林组(研究组,23例)和阿米替林组(对照组,22例),均治疗8周.应用认知功能筛查量表(CASI)评定老年抑郁症患者认知缺损的状况;应用汉密尔顿抑郁量表(HAMD)和治疗意外症状量表(TESS)评定临床疗效及不良反应.结果 经过8周的治疗,研究组患者的CASI评分中的注意力、心算、新近记忆、远时记忆、类聚流畅性5个因子得分与正常值比较差异无统计学意义,而对照组患者该5个因子得分仍明显低于正常值(P<0.05).治疗后两组HAMD评分均明显下降,但组间比较差异无统计学意义.治疗后2、4、8周,对照组TESS总分明显高于研究组(P<0.05或<0.01).结论 盐酸舍曲林治疗老年抑郁症患者认知功能的疗效优于阿米替林,临床抗抑郁症的疗效与阿米替林相当,但不良反应小,耐受性好,可作为老年抑郁症的一线用药.     

Screening accuracy for late-life depression in primary care: a systematic review

OBJECTIVE: To determine the accuracy of depression screening instruments for older adults in primary care. STUDY DESIGN: Systematic review. DATA SOURCES: MEDLINE, PsycINFO (search dates 1966 to January 2002), and the Cochrane database on depression, anxiety and neurosis. We also searched the second Guide to Clinical Preventive Services, the 1993 Agency for Health Care Policy and Research Clinical Practice Guideline on Depression, and recent systematic reviews. Hand-checking of bibliographies and extensive peer review were also used to identify potential articles. OUTCOMES MEASURED: A predefined search strategy targeted only studies of adults aged 65 years or older in primary care or community settings, including long-term care. Articles were included in this review if they reported original data and tested depression screening instruments against a criterion standard, yielding sensitivity and specificity. RESULTS: Eighteen articles met criteria and are included in this review, representing 9 different screening instruments. The most commonly evaluated were the Geriatric Depression Scale (30- and 15-item versions), the Center for Epidemiologic Studies Depression Scale, and the SelfCARE(D). Differences in the performance of these 3 instruments were minimal; sensitivities ranged from 74% to 100% and specificities ranged from 53% to 98%. CONCLUSIONS: Accurate and feasible screening instruments are available for detecting late-life depression in primary care. More research is needed to determine the accuracy of depression screening instruments for demented individuals, and for those with subthreshold depressive disorders.     

'Justifiable depression': how primary care professionals and patients view late-life depression? A qualitative study

BACKGROUND: Depression is the commonest mental health problem in elderly people and continues to be underdiagnosed and undertreated. AIM: To explore the ways that primary care professionals and patients view the causes and management of late-life depression. DESIGN: A qualitative study using semistructured interviews. SETTING: One Primary Care Trust in North West England. PARTICIPANTS: Fifteen primary care practitioners comprising nine GPs, three practice nurses, two district nurses and one community nurse; twenty patients who were over the age of 60 and who were participating in a feasibility study of a new model of care for late-life depression [PRIDE Trial: PRimary care Intervention for Depression in the Elderly (a feasibility study in Central Manchester funded by the Department of Health)]. RESULTS: Primary care practitioners conceptualized late-life depression as a problem of their everyday work, rather than as an objective diagnostic category. They described depression as part of a spectrum including loneliness, lack of social network, reduction in function and viewed depression as 'understandable' and 'justifiable'. This view was shared by patients. Therapeutic nihilism, the feeling that nothing could be done for this group of patients, was a feature of all primary care professionals' interviews. Patients' views were characterized by passivity and limited expectations of treatment. Depression was not viewed as a legitimate illness to be taken to the GP. Primary care professionals recognized that managing late-life depression did fall within their remit, but identified limitations in their own skills and capabilities in this area, as well as a lack of other resources to which they could refer patients. CONCLUSION: This study highlights the complicated nature of the diagnosis and management of late-life depression. Protocols for the diagnosis and treatment of depression emphasis the biomedical model which does not fit with the everyday experience of GPs or elderly patients who share the views of primary care professionals that depression is a consequence of social and contextual issues. There is a need for the development of evidence-based provision for older people with depression within primary care, but also a need for elderly patients to be made aware of the legitimacy of presenting low mood and misery to their primary care professional.     

Risk factors for late-life depression: A prospective cohort study among older women

Depression prevention requires identifying key risk contributors. Prior studies have identified several factors related to late-life depression but have seldom addressed factors jointly or in dose-response fashion. This study aimed to examine a wide range of potential predisposing factors and to estimate individual and joint contributions to risk of late-life depression in women. A total of 21,728 women aged ≥ 65 years, without prior depression, in the Nurses' Health Study conducted in the United States were followed from 2000 to 2010. Demographic, social, lifestyle/behavioral and health variables were selected a priori from the literature or previous findings in this cohort. Depression was defined as physician/clinician-diagnosed depression, regular antidepressant use, or the presence of severe depressive symptoms. During 10-year follow-up, 3945 incident cases were identified. After simultaneous multivariable-adjustment, multiple factors in the domains of social stress (lower self-rated societal position and high volume of caregiving to disabled/ill relatives), unfavorable lifestyle (smoking, physical inactivity, heavy or binge drinking), and poor physical health (multiple comorbidity burden, excessive sleep, difficulty falling/staying asleep, bodily pain, and physical/functional limitation or disability) were significantly associated with higher depression risk; many featured dose-response relationships. Sensitivity analyses that excluded outcomes within 2 years yielded similar estimates. The total population attributable fraction for all factors was 55.5%. Physical/functional limitation accounted for one-quarter of population attributable fraction, followed by problematic sleep, inadequate exercise, and pain (combining for one-third of population attributable fraction). Efforts to remediate or prevent these factors may contribute to an efficient strategy for late-life depression prevention in women.     

路优泰并用电针治疗中度抑郁症的疗效观察

目的对比电针并用路优泰（治疗组）与单用路优泰（对照组）治疗中度抑郁的疗效。方法将71例抑郁症患者随机分为治疗组36例,对照组35例,治疗组VI服路优泰900mg／d,同时合并应用穴位治疗,对照组单用路优泰900mg／d,口服治疗,疗程6周,于治疗前及治疗后2、4、6周评定一次汉密尔顿抑郁量表（HAMD）,汉密尔顿焦虑量表（HAMA）副反应量表（TESS）。并与治疗前及治疗后6周评定简易应付方式问卷。结果治疗6周后,治疗组总有效率为85．7％,对照组总有效率为83．3％;HAMD、HAMA量表评分显示,治疗组2个量表评分从第2周末开始下降,对照组第2周末变化不明显;TESS量表评分显示,2组在不良反应方面差异无统计学意义。结论路优泰合并电针与单用路优泰疗效相近,但起效快,依从性高。     

“心境促进协作医疗”模式对社区老年抑郁症生活质量影响及初步卫生经济学评价

目的探讨＂心境-促进协作医疗＂（IMPACT）管理模式对社区老年抑郁症患者生活质量影响及卫生经济学价值。方法对30名社区老年抑郁症患者实施为期2年的IMPACT管理治疗,按1：1配对另30例作为对照组,对其实施常规的社区精神病康复管理。在干预第一年末及第二年末使用汉密尔顿量表（HAMD）、家庭负担表（FIS）、生活满意度（LSR）进行评定并观察费用成本。结果在实施干预的第一年末和第二年末,干预组患者的HAMD和FIS得分较对照组显著降低、干预组患者LSR得分较对照组显著升高（列联表卡方检验结果中,χ^2均大于5.9,P值均〈0.05）。2年内干预组患者总费用低于对照组,表现在门诊费用、住院费用、社区防治费用和家属误工费用等方面干预者患者的支出要明显少于对照组患者（t检验结果中,P值均〈0.05）;同时,两者患者在药物费用支出方面无显著差异。结论 IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,并显著降低患者因疾病产生的各项费用成本。     

云南农村初中生抑郁症状及其相关因素研究

目的探讨农村初中生抑郁症状状况及其相关因素的关系。方法采用流调中心用抑郁量表(CES-D)、青少年生活事件量表(ASLEC)、中学生应对方式量表、社会支持评定量表(SSRS)和自编问卷对云南省2293名农村初中生进行调查。结果抑郁症状检出率为22.2%,其中男生20.9%,女生23.7%,男女生差异无统计学意义(χ2=2.696,P﹥0.05);初一18.8%,初二26.3,初三21.7%,各年级间差异有统计学意义(χ2=12.740,P﹤0.05);汉族23.7%,彝族21.9%,白族15.5%,哈尼族30.1%,其他民族22.7%,各民族间差异有统计学意义(χ2=20.974,P﹤0.001)。农村初中生抑郁症状与生活事件、应对方式、社会支持各因子均有显著的相关关系。结论农村初中生抑郁症状普遍存在,且抑郁症状与生活事件、应对方式、社会支持关系密切,受多种因素的影响。     

中学生抑郁与其相关影响因素的综合研究

目的 探讨中学生抑郁状况与其相关因素的关系，以便为中学生抑郁问题的理论研究和辅导工作提供依据。方法 采用中学生抑郁量表、青少年生活事件量表、中学生父母教养方式量表、艾森克人格问卷和应对量表，对558名中学生进行调查。结果 中学生整体抑郁水平较低，但有32．9％的学生存在不同程度的抑郁问题，男女生在抑郁方面不存在性别差异；年龄差异在中学生抑郁上表现十分明显，高中生的抑郁状况要高于初中生。中学生抑郁情绪与生活事件、父母教养方式、人格和应对方式各因子均有十分显的相关关系；进一步回归分析结果表明，有6个因素对抑郁的预测作用十分明显，具体为不良情绪应对、内外向、学习压力、退避、神经质、父理解型教养方式。结论 中学生抑郁与生活事件、父母教养方式、人格和应对方式关系密切，受多种因素的影响。     

盐酸氟西汀治疗脑卒中后抑郁及神经功能缺损的疗效观察

目的：观察盐酸氟西汀治疗脑卒中后抑郁及神经功能缺损的疗效。方法：对86例脑卒中后抑郁状态患者,随机分为治疗组（加用盐酸氟西汀）和对照组（常规治疗）各43例进行对照观察。治疗前后行汉密尔顿抑郁量表（HAMD）、日常生活能力Barthel指数（BL）量表及神经功能缺损评分（SSS）量表进行评定其疗效和不良反应。结果：治疗组HAMD评分治疗后较治疗前显著下降（P〈0．01）,对照组治疗后与治疗前比较无显著差异（P〉0．05）。治疗组治疗后SSS评分显著降低,BI评分明显提高,与对照组比较也有显著差异（均P〈0．01）。结论：盐酸氟西汀治疗脑卒中后抑郁状态不仅对抑郁有明显效果,且可促进脑卒中后神经功能的恢复。不良反应小。     

Binge eating and psychopathology in severely obese adolescents

OBJECTIVE: The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. METHOD: Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State-Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers-Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score. RESULTS: Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters. DISCUSSION: As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress.     

Temperament, post-partum depression, hopelessness, and suicide risk among women soon after delivering

The aim of the authors in this study was to assess the prevalence of postpartum depression and evaluate the association of affective temperaments with emotional disorders in a sample of 92 pregnant women consecutively admitted for delivery between March and December 2009. In the first few days postpartum, women completed the Suicidal History Self-rating Screening Scale, the Beck Hopelessness Scale, the Edinburgh Postnatal Depression Scale, the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire, and the Gotland Male Depression Scale. Fifty percent of the women reported an Edinburgh Postnatal Depression Scale score of 9 or higher, and 23% a score of 13 or higher. Women with a dysphoric-dysregulated temperament had higher mean scores on the Beck Hopelessness Scale (p < 0.05), the Gotland Male Depression Scale (p < 0.001), the Edinburgh Postnatal Depression Scale (p < 0.001), and the Suicidal History Self-Rating Screening Scale (p < 0.01) than other women after adjusting for covariates. Multiple logistic regression analysis with the temperament groups as the dependent variable indicated that only the Gotland Male Depression Scale was significantly associated with temperament when controlling for the presence of other variables. Women with a dysphoric-dysregulated temperament were 1.23 times as likely to have higher depressive symptom scores. Future studies should evaluate the effectiveness of psychiatric screening programs in the postpartum period as well as factors associated with depression and suicidality during the same period.