Učestalost depresivnosti u primarnoj zdravstvenoj zaštiti i mogućnosti ranog prepoznavanja

Abstract

Uvod: Primarna zdravstvena zaštita (PZZ) ima centralnu ulogu u koordinaciji i kontinuitetu zdravstvene zaštite za pacijente ili korisnike, zbog ĉega je ukljuĉivanje lekara opšte medicine od velikog javnozdravstvenog znaĉaja u mnogim oblastima, pa tako i u domenu unapreĊenja mentalnog zdravlja. U savremenom svetu depresivni poremećaji predstavljaju veliko opterećenje za društvo. Teško ih je prepoznati u PZZ, jer nema standardnog kliniĉkog testa za kvantifikaciju teţine depresije. Ciljevi: Ciljevi istraţivanja obuhvatili su ispitivanje prevalencije depresivnosti kod osoba koje se obraćaju za pomoć ustanovi PZZ, ispitivanje povezanosti depresivnosti sa traumatskim iskustvima, socijalno-demografskim i psihološkim faktorima, utvrĊivanje nivoa depresivnosti jedan mesec nakon prvog ispitivanja i analizu ishoda u vezi sa razliĉitim faktorima (postavljanjem dijagnoze depresije od strane lekara specijaliste, propisanom farmakoterapijom, socijalno-demografskim faktorima, psihološkim faktorima). Metodologija: Istraţivanje je sprovedeno u Domu zdravlja „Zvezdara” u Beogradu (Republika Srbija). Prospektivna kohortna studija je obuhvatila sve odrasle pacijente (starosti od 18 ili više godina) koji su u januaru 2018. godine posetili svog lekara opšte medicine iz bilo kog razloga. Kriterijum za iskljuĉivanje iz istraţivanja bio je već zakazan pregled kod psihijatra. U analizu je konaĉno ukljuĉeno 426 pacijenata. Svi uĉesnici su bili informisani o cilju istraţivanja i prikupljanju podataka i dali su pisanu saglasnost za uĉešće u studiji. Istraţivanje je odobreno od strane Etiĉkih komiteta Doma zdravlja „Zvezdara” [1641/3] i Medicinskog fakulteta Univerziteta u Beogradu [29/VI-15]. Instrument istraţivanja predstavljao je upitnik koji je sadrţao ĉetiri dela: 1. socijalno-demografske i socijalno-ekonomske karakteristike; 2. karakteristike ţivotnog stila; 3. fiziĉko zdravlje i 4. mentalno zdravlje. Mentalno zdravlje ispitanika procenjivano je prilikom prve i druge posete (na poĉetku studije i nakon 4 nedelje) primenom pet upitnika: Upitnik o zdravlju pacijenta (Patient Health Questionnaire – PHQ-9), Skala za procenu depresije, anksioznosti i stresa (Depression, Anxiety and Stress Scale – DASS), Lista ugroţavajućih ţivotnih dogaĊaja (List of Threatening Experiences – LTE), Upitnik o traumatskim iskustvima u detinjstvu (Childhood Trauma Questionnaire – CTQ) i Upitnik za procenu liĉnosti i temperamenta (Eysenck Personality Questionnaire – EPQ 100). Kao skrining test za procenu depresivnosti kod ispitanika na prvoj poseti korišćen je Upitnik o zdravlju pacijenta (PHQ-9). Ukoliko je ispitanik imao skor PHQ-9 ≥ 10, smatran je depresivnim i potom je sprovedena intervencija od strane lekara opšte medicine koja je podrazumevala upućivanje psihijatru i dalje farmakoterapijske intervencije. Pri drugoj poseti, lekari opšte medicine su pratili ishode intervencija. Izvršeno je odreĊivanje prevalencije depresivnosti i prediktora za njenu pojavu u obe vremenske taĉke. Statistiĉka analiza prikupljenih podataka sprovedena je metodama deskriptivne i inferencijalne statistike: x2 testom, Kruskal–Valisovim testom, Studentovim t-testom, analizom varijanse (ANOVA), korelacionom testom (Pirsonovim i Spirmanovim testom korelacije) i multivarijatnom logistiĉkom regresionom analizom. Svi podaci su analizirani pomoću softvera SPSS 20.0 (IBM Corp. IBM SPSS Statistics za Windows, verzija 20.0. Armonk, NY: IBM Corp.). Rezultati: Prevalencija depresivnosti u PZZ je 35,9% merena PHQ-9 upitnikom prilikom prve posete. Identifikovani su statistiĉki znaĉajni prediktori za pojavu depresivnosti...

health care for patients or users. Therefore, the involvement of general practitioners is of great public health importance in many areas, including mental health. In the modern world, depressive disorders pose a great burden on society. They are difficult to recognize in PHC because there is no standard clinical test to quantify the severity of depression, and patients do not present their symptoms clearly. Objectives: To assess the frequency, predictors of depression and outcomes in persons attending PHC facilities. Methodology: Respondents aged ≥ 18 were successively included in the research during January 2018. Initially and after 4 weeks, questionnaires were filled out in order to collect demographic, socioeconomic, clinical characteristics, assessment of depression, traumatic childhood experiences, life-threatening events and assessment of psychological factors. The prevalence of depression and predictors of its occurrence were determinedat both time points. The study sample included 426 respondents. Results: A high prevalence of depression of 35.9% was determined during the first visit to PHC facility, using PHQ-9 questionnaire. In the total sample, 31.2% of respondents were referred to a psychiatrist, 24.2% were diagnosed with mental disorder, and 19.2% were prescribed pharmacotherapy. After 4 weeks, there was a decrease in the prevalence of depression, to 24.4%. The results of the interventions prove the validity of the application of the PHQ-9 test for depression screening in PHC. Statistically significant predictors for the occurrence of depression have been identified: prior consultation with a psychiatrist (odds ratio, OR = 3.8; p < 0.001), chronic therapy (OR = 3.8; p < 0.001), being single (OR = 2.4; p = 0.008), widowed or divorced (OR = 5; p < 0.001), unemployment (OR = 3.6; p < 0.001), emotional (OR = 1.2; p = 0.009) or physical abuse (OR = 1.7; p < 0.001) in childhood, personality neuroticism (OR = 2.9; p < 0.001), threatening life events in the last 6 months: serious personal illness, serious injury or assault (OR = 5.7; p < 0.001), serious problems with a close friend, neighbor or relative (OR = 7.9; p < 0.001), great financial crisis (OR = 4; p < 0.001) and dismissal from work (OR = 3.7; p = 0.024). Conclusions: Through the conducted research, we proposed the program of early recognition of depression in the PHC institution in the Republic of Serbia, and documented its effect. The influence of psychological, socioeconomic and demographic factors of the respondents in the development of depression was quantified. By recognizing these patients, with the support and application of the PHQ-9 questionnaire in everyday practice, timely referral of patients to a psychiatrist, shortening the time until diagnosis and application of adequate therapy can be achieved, thus improving mental health.