抑郁症和自杀风险查:美国预防服务工作组的最新证据报告和系统审查
Elizabeth A O'Connor1, Leslie A Perdue1, Erin L Coppola1
1Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon.
JAMA
|June 20, 2023
概括
在初级保健中进行抑郁查有助于改善结果, 然而,缺乏关于初级保健中自杀风险查干预措施的证据,这突显了研究的重大缺陷.
科学领域:
- 主要护理医学
- 心理健康检查
- 基于证据的实践
背景情况:
- 抑郁症是一种普遍的疾病,对公众健康造成重大负担.
- 自杀率上升, 需要在初级保健机构实施有效的查和干预策略.
研究的目的:
- 评估初级保健中抑郁症和自杀风险查和治疗的有效性和安全性.
- 评估这些疾病的诊断仪器的准确性.
主要方法:
- 英语研究的系统审查,包括随机临床试验,观察性研究和系统审查.
- 数据综合包括有足够证据的定性分析和元分析.
- 在 MEDLINE,PsychINFO 和 Cochrane 图书馆搜索到 2022 年 9 月,
主要成果:
- 抑郁症查干预与抑郁症患病率降低相关 (OR,0. 60).
- 几种仪器对抑郁查的准确度足够 (例如PHQ-9敏感度为0.85,特异性为0.85).
- 心理和药物治疗抑郁症是有益的,尽管第二代抗抑郁药显示自杀企图的风险略有增加 (0.7%对0.3%).
- 与常规护理相比,自杀风险查干预没有显示出改善的结果.
结论:
- 在初级保健中支持抑郁症查,包括怀孕期间和产后.
- 在初级保健机构中对自杀风险查存在重大证据缺口.
- 需要进一步的研究来开发和验证有效的自杀风险查工具和初级保健干预措施.
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