Características clínicas del trastornodepresivo mayor en tratamiento en elnivel secundario de atención

Marzo_2017

335 artículo de investigación Rev Med Chile 2017; 145: 335-343 Características clínicas del trastorno depresivo mayor en tratamiento en el nivel secundario de atención Lilian Salvo1,2,3,a, Sandra Saldivia4,b,c, Carlos Parra3,5,6, Román Rodríguez3,6, Manuel Cifuentes7,d, Paola Acevedo3,b, Marcela Díaz3,b, Mitza Ormazabal5,b, Ivonne Guerra5,b, Nicol Navarrete6,b, Verónica Bravo6,b, Andrea Castrob Clinical features of major depressive disorders treated in secondary health care facilities in Chile Background: Depression is considered the second leading cause of disability worldwide. Aim: To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE). Material and Methods: Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied. Results: Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features. Conclusions: MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely. (Rev Med Chile 2017; 145: 335-343) Key words: Depression; Outpatients; Public Health; Secondary Care. 1Programa Doctorado en Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción. Concepción, Chile. 2Facultad de Medicina, Universidad Católica de la Santísima Concepción. Concepción, Chile. 3Hospital Clínico Herminda Martín. Chillán, Chile. 4Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción. Concepción, Chile. 5COSAM Chillán. Chillán, Chile. 6COSAM San Carlos. San Carlos, Chile. 7Research and evaluation Unit, Center for Health Policy and Research, University of Massachusetts Medical School, Massachusetts, USA. aDoctor en Salud Mental. bPsicóloga. cDoctor en Psicología. dScD MD Epidemiology. Fuente de apoyo financiero: El presente artículo no contó con apoyo financiero. Recibido el 24 de mayo 2016, aceptado el 6 de marzo de 2017. Correspondencia a: Lilian Salvo G. Bulnes 473, Chillán. lsalvog@gmail.com La depresión constituye un problema para la salud pública en el mundo y en Chile. Al valorar la carga de enfermedad, la Organización Mundial de la Salud, el año 2010, estimó que el trastorno depresivo mayor (TDM) ocupó el lugar número 11, como causa de más discapacidad y mortalidad; a la vez, la consideró la segunda causa de discapacidad en el mundo1,2. Asimismo, es responsable de más de 40% de las alteraciones de las capacidades causadas por los trastornos mentales3,4. Por lo tanto, es evidente que se deben desplegar diversas estrategias de afrontamiento en todos los niveles de atención. Se ha demostrado que la carga de enfermedad causada por el TDM puede ser reducida si se aumenta la cobertura del tratamiento5. Pero, se


Marzo_2017
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