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Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data.

抑郁症的精神和躯体共病: 使用德国全国门诊索赔数据对 202 个诊断组进行全面的横断面分析。

  • 影响因子:3.06
  • DOI:10.1186/s12888-020-02546-8
  • 作者列表:"Steffen A","Nübel J","Jacobi F","Bätzing J","Holstiege J
  • 发表时间:2020-03-30
Abstract

BACKGROUND:Depression is frequently accompanied by other mental disorders and various somatic diseases; however, previous comorbidity studies often relied on self-reported data and have not simultaneously assessed the entire spectrum of mental and somatic diagnoses. The aim is to provide a complete picture of mental and somatic comorbidity of depression in routine outpatient care in a high income country with a relatively well equipped health care system. METHODS:Using ambulatory claims data covering 87% of the German population (age 15+), we designed a cross-sectional study by identifying persons diagnosed with mild, moderate and severe depression in 2017 (N = 6.3 million) and a control group matched 4:1 on sex, 5-year age group and region of residence (N = 25.2 million). Stratified by severity, we calculated the prevalence of 202 diagnosis groups included in the ICD-10 in persons with depression as compared to matched controls using prevalence ratios (PR). RESULTS:Nearly all mental disorders were at least twice as prevalent in persons with depression relative to controls, showing a dose-response relationship with depression severity. Irrespective of severity, the three most prevalent somatic comorbid diagnosis groups were 'other dorsopathies' (M50-M54), 'hypertensive diseases' (I10-I15) and 'metabolic disorders' (E70-E90), exhibiting PRs in moderate depression of 1.56, 1.23 and 1.33, respectively. Strong associations were revealed with diseases of the central nervous system (i.e. multiple sclerosis) and several neurological diseases, among them sleep disorders, migraine and epilepsy, most of them exhibiting at least 2- to 3-fold higher prevalences in depression relative to controls. Utilization of health care was higher among depression cases compared to controls. CONCLUSIONS:The present study based on data from nearly the complete adolescent and adult population in Germany comprehensively illustrates the comorbidity status of persons diagnosed with depression as coded in routine health care. Our study should contribute to increasing the awareness of the strong interconnection of depression with all other mental and the vast majority of somatic diseases. Our findings underscore clinical and health-economic relevance and the necessity of systematically addressing the high comorbidity of depression and somatic as well as other mental diseases through prevention, early identification and adequate management of depressive symptoms.

摘要

背景: 抑郁症常伴有其他精神障碍和各种躯体疾病; 然而,以前的共病研究往往依赖于自我报告的数据,没有同时评估精神和躯体诊断的全部范围。目的是在一个设备相对完善的医疗保健系统的高收入国家,在常规门诊护理中提供抑郁症心理和躯体共病的全貌。 方法: 利用覆盖 87% 德国人群 (15 岁以上) 的门诊索赔数据,我们设计了一项横断面研究,通过识别被诊断为轻度、 2017年中度和重度抑郁 (n = 630万),对照组在性别、 5 岁年龄组和居住地区方面与 4:1 相匹配 (n = 2520万)。按严重程度分层,我们使用患病率比 (PR) 计算了 ICD-10 抑郁症患者中包括的 202 个诊断组与匹配对照者的患病率。 结果: 几乎所有精神障碍在抑郁症患者中的患病率至少是对照组的两倍,显示出与抑郁症严重程度的剂量-反应关系。无论严重程度如何,三个最常见的躯体共病诊断组是 “其他躯体疾病” (M50-M54) 、 “高血压疾病” (I10-I15) 和 “代谢障碍” (E70-E90),中度抑郁的 PRs 为 1.56,分别为 1.23 和 1.33。与中枢神经系统疾病 (多发性硬化症) 和几种神经系统疾病,其中包括睡眠障碍、偏头痛和癫痫,他们中的大多数表现出抑郁症相对于对照组的患病率至少高 2 至 3 倍。与对照组相比,抑郁症病例的卫生保健利用率较高。 结论: 本研究基于德国几乎完整的青少年和成年人群的数据,全面说明了常规卫生保健中编码的抑郁症患者的共病状况。我们的研究应该有助于提高对抑郁症与所有其他精神和绝大多数躯体疾病的强烈联系的认识。我们的研究结果强调了临床和健康-经济相关性,以及通过预防、早期识别和充分管理抑郁症状来系统解决抑郁症和躯体以及其他精神疾病的高共病的必要性。

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来源期刊:Molecular psychiatry
DOI:10.1038/s41380-020-0649-0
作者列表:["Li C","Meng F","Garza JC","Liu J","Lei Y","Kirov SA","Guo M","Lu XY"]

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影响因子:5.83
发表时间:2020-01-22
DOI:10.1523/JNEUROSCI.0786-19.2019
作者列表:["Torretta S","Rampino A","Basso M","Pergola G","Di Carlo P","Shin JH","Kleinman JE","Hyde TM","Weinberger DR","Masellis R","Blasi G","Pennuto M","Bertolino A"]

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翻译标题与摘要 下载文献
影响因子:6.22
发表时间:2020-01-17
DOI:10.1038/s41386-020-0614-2
作者列表:["Chadha R","Meador-Woodruff JH"]

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