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背景相对于其他患者来说,心力衰竭患者更容易患抑郁。但是由于抑郁和心力衰竭这两种疾病有些症状相似,诊断心力衰竭患者是否患抑郁比较困难。本研究旨在调查作为心力衰竭患者的首诊医生,全科医生对心力衰竭患者抑郁状况认知情况及其影响因素。方法此项横断面观察性研究的研究对象为3 224例社区心力衰竭患者。使用医院焦虑抑郁量表、PHQ-9抑郁症筛查量表及PROMIS焦虑抑郁量表中的部分条目调查心力衰竭患者的抑郁状况并对结果进行评估计算。对为这些患者接诊的272例全科医生就患者的躯体和心理共病情况进行了电话采访。使用描述性统计方法分析全科医生对患者的抑郁状况认知情况。使用Logistic回归分析影响全科医生对患者抑郁状况认知情况的因素。结果全科医生仅能诊断出35%的患者患有抑郁。影响其对心力衰竭患者抑郁状况认知情况的因素有:患者文化水平较高,全科医生了解到患者曾患有抑郁,调查前6个月内患者因为情感压力就诊,调查前6个月内患者多次联系全科医生,经纽约心脏病协会(NYHA)分级标准评估的重度心力衰竭,以及较为严重的抑郁症状。全科医生是否学过心理学或精神病学与其对心力衰竭患者抑郁状况的认知情况无关。结论研究表明,全科医生对心力衰竭患者的抑郁状况的认知水平较低。其受到多种因素的影响,包括对认知的定义以及社区临床实践情况。鼓励患者谈其情感压力,花足够的时间去诊疗患者,包括了解其抑郁病史,以及特别用心诊疗文化水平低的患者均可以提升全科医生对心力衰竭患者抑郁状况的认知水平。然而,相对于精神病学诊断标准,全科医生诊断出心力衰竭患者患有抑郁对患者预后及其生活质量的影响有待于进一步调查。
Background Compared with other patients, heart failure patients are more prone to depression. However, due to the similar symptoms of the two diseases of depression and heart failure, it is difficult to diagnose depression in patients with heart failure. The purpose of this study was to investigate the cognitive status of depression and its influencing factors among first-time physicians and general practitioners who are heart failure patients. Methods This cross-sectional observational study was conducted in 3 224 community-based patients with heart failure. Using the hospital anxiety and depression scale, the PHQ-9 depression screening scale and the PROMIS anxiety and depression scale, we investigated the depression status in patients with heart failure and evaluated the results. A total of 272 GPs interviewed for these patients conducted a telephone interview on the physical and psychological comorbidity of the patients. Descriptive statistics were used to analyze general cognitive status of patients with depression. Logistic regression analysis was used to analyze the factors that influence general cognitive status in patients with depression. Results GPs were only able to diagnose depression in 35% of patients. The factors affecting their cognition of depression in patients with heart failure are: higher education level of the patients, general practitioners who have experienced the depression of the patients, patients with emotional stress during the first 6 months of the survey, the first 6 months of the survey Patients repeatedly contacted their GP, severe heart failure as assessed by the New York Heart Association (NYHA) grading scale, and more severe depressive symptoms. Whether general practitioners have studied psychology or psychiatry has nothing to do with their cognition of depression in patients with heart failure. Conclusions Studies have shown that general practitioners have a low level of cognitive decline in patients with heart failure. It is influenced by many factors, including the definition of cognition and the clinical practice in the community. Encouraging patients to talk about their emotional stress, spending enough time to diagnose their patients, including understanding their depressive history, and treating patients with a low educational level with special attentive care, can elevate the level of generalized cognitive impairment in heart failure patients. However, relative to the diagnostic criteria of psychiatry, general practitioners diagnosed with heart failure patients suffering from depression prognosis and quality of life remains to be further investigated.