Depression affects elderly people's lives more than physical illnesses
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《英国医生杂志》
Severe depression impairs elderly patients' lives more than serious medical illnesses, and treatment of depression "has the potential to improve patients' lives in spite of other medical comorbidities," says a multicentre randomised controlled US study published in the Annals of Family Medicine ( 2004;2: 555-562).
Depression is often viewed as resulting from medical illness, but it is also related to psychosocial factors, such as the death of a spouse, retirement, social isolation, and diminished income, says the study.
Treating depression in primary care can improve patients' quality of life despite their other illnesses, the authors say. "Indeed, it may be that treatment for depression can lead to more dramatic improvements in functional status, disability, and quality of life than interventions for other chronic illnesses in this age group."
Depression can result from psychosocial factors, such as the death of a spouse, reduced income, or social isolation
Credit: BETH A KEISER/AP
The study enrolled 1801 patients aged 60 and older with major depression or dysthymia from eight US healthcare organisations. The aim was to develop a sample of depressed older patients who were to be treated under real-world conditions, comparing usual care with collaborative disease management. This study reports on the effects of depression and medical illnesses in these patients.
Lead author Dr Polly Hitchcock Noel, of the South Texas Veterans Health Care System in San Antonio, told the BMJ that 45% of patients who received collaborative treatment for 12 months had a 50% or better reduction in depressive symptoms compared with only 19% of patients receiving usual care. Collaborative care included treatment by a depression care manager (a nurse or psychologist) supervised by a psychiatrist, and treatment with antidepressants or short psychotherapy. Usual care patients could use any primary care or specialty mental care services available to them.
Chronic depression affected 83% of patients, 10.6% had post-traumatic stress disorder, 21.7% had panic disorder, and 35.4% had mild cognitive impairment.
Medical problems included chronic lung disease (23.3%,), hypertension (57.9%), diabetes (23.2%), arthritis (55.6%), sensory deficit (55.2%), cancer (excluding skin cancer) (10.9%), neurological disease (8.4%), heart disease (27.6%), chronic pain (56.8%), gastrointestinal disease (20.9%), and urinary or prostate disease (38.7%). Patients had a mean of 3.79 chronic diseases (standard error 0.046).
"Controlling for all other variables, depression severity was the only psychological or medical variable that was significantly associated with all four outcomes ... As depression severity increased, quality of life and physical and mental functioning declined, while disability increased," the authors wrote, commenting that depression has a "devastating impact... on both emotional and physical functioning in older adults."(Janice Hopkins Tanne)
Depression is often viewed as resulting from medical illness, but it is also related to psychosocial factors, such as the death of a spouse, retirement, social isolation, and diminished income, says the study.
Treating depression in primary care can improve patients' quality of life despite their other illnesses, the authors say. "Indeed, it may be that treatment for depression can lead to more dramatic improvements in functional status, disability, and quality of life than interventions for other chronic illnesses in this age group."
Depression can result from psychosocial factors, such as the death of a spouse, reduced income, or social isolation
Credit: BETH A KEISER/AP
The study enrolled 1801 patients aged 60 and older with major depression or dysthymia from eight US healthcare organisations. The aim was to develop a sample of depressed older patients who were to be treated under real-world conditions, comparing usual care with collaborative disease management. This study reports on the effects of depression and medical illnesses in these patients.
Lead author Dr Polly Hitchcock Noel, of the South Texas Veterans Health Care System in San Antonio, told the BMJ that 45% of patients who received collaborative treatment for 12 months had a 50% or better reduction in depressive symptoms compared with only 19% of patients receiving usual care. Collaborative care included treatment by a depression care manager (a nurse or psychologist) supervised by a psychiatrist, and treatment with antidepressants or short psychotherapy. Usual care patients could use any primary care or specialty mental care services available to them.
Chronic depression affected 83% of patients, 10.6% had post-traumatic stress disorder, 21.7% had panic disorder, and 35.4% had mild cognitive impairment.
Medical problems included chronic lung disease (23.3%,), hypertension (57.9%), diabetes (23.2%), arthritis (55.6%), sensory deficit (55.2%), cancer (excluding skin cancer) (10.9%), neurological disease (8.4%), heart disease (27.6%), chronic pain (56.8%), gastrointestinal disease (20.9%), and urinary or prostate disease (38.7%). Patients had a mean of 3.79 chronic diseases (standard error 0.046).
"Controlling for all other variables, depression severity was the only psychological or medical variable that was significantly associated with all four outcomes ... As depression severity increased, quality of life and physical and mental functioning declined, while disability increased," the authors wrote, commenting that depression has a "devastating impact... on both emotional and physical functioning in older adults."(Janice Hopkins Tanne)