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Depression als komorbide Störung in der primärärztlichen Versorgung

Depression as a comorbid disorder in primary care

  • Leitthema: Depression
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Auf der Grundlage der DETECT-Studie1 wird die querschnittliche Assoziation depressiver Störungen mit einem weiten Spektrum körperlicher Erkrankungen in einer bundesweit repräsentativen Stichprobe von 51.000 Patienten aus der primärärztlichen Versorgung in Deutschland sowie der Zusammenhang mit gesundheitsbezogener Lebensqualität und Arbeitsunfähigkeit untersucht. Das Vorliegen einer Depression wurde über den Depression Screening Questionnaire (DSQ) mit seinem ICD-10 Algorithmus ermittelt. Bei einer Gesamt-Querschnittsprävalenz depressiver Störungen von 7,5 % ergaben sich erhöhte Depressionsraten und signifikante Assoziationen für nahezu alle untersuchten Krankheitsgruppen. (1) Ko- und Multimorbidität somatischer als auch somatischer mit depressiven Störungen sind die Regel: „Reine“ (nicht komorbide) Depressionen sind ebenso wie reine somatische Erkrankungen die Ausnahme. (2) Das Depressionsrisiko steigt stetig mit der Anzahl komorbider Krankheiten. (3) Besonders ausgeprägte Assoziationen ergaben sich für schwergradige Herzinsuffizienzen (OR: 5,8), diabetische Folgekomplikationen (OR: 1,7–2,0), koronare Herzerkrankungen (KHK) (OR: 1,7), zerebrale Insulte (OR: 2,5) sowie muskuloskelettäre Erkrankungen (OR: 1,5). Demgegenüber waren z. B. die Raten bei Hyperlipidämie (OR: 1,1) nur leicht erhöht. (4) Komorbide Depression und steigende Multimorbidität waren mit stetig zunehmenden Arbeitsunfähigkeits- raten und absinkender gesundheitsbezogener Lebensqualität assoziiert. Angesichts der quantitativen Bedeutung der Depression sowie des mit Multimorbidität drastisch ansteigenden Depressionsrisikos und der damit verbundenen hohen direkten und indirekten Krankheitslast für das Gesundheitssystem und die Gesellschaft ist das hohe Ausmaß der Unterschätzung von Depression in der Routineversorgung besorgniserregend.

Abstract

As part of the DETECT study, a nationwide representative clinical-epidemiological study, the frequency and associated problems of comorbid depression with a wide range of somatic illnesses were studied in N = 51,000 primary care patients. Further the association with health related quality of life and disability is examined. Depression was assessed with the Depression Screening Questionnaire (DSQ) with an ICD-10 algorithm. Results: (1) 7.5 % of all primary care patients met criteria for ICD-10 depressive disorders. (2) Depression risk was increased whenever any somatic disorder was present and increased in a dose-response relationship by number of comorbid conditions. (3) Elevation of depression risk was fairly independent of type of diagnosis, although associations with coronary heart disease (OR: 1.7), diabetic complications (OR: 1.7– 2.0), stroke (OR: 2.5) and pain-related chronic disorders (OR: 1.5) were particularly pronounced. Moderate associations were found for hyperlipidaemia (OR: 1.1). (4) Associated with the increasing number of comorbid conditions, patients with comor- bid depression had increasingly more disability days and lower health related quality of life. It is concluded that the degree to which the frequency and the deleterious effects of comorbid depression is underestimated and unrecognized is alarming. The use of comorbidity indices might improve recognition.

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Author information

Authors and Affiliations

  1. Technische Universität Dresden, BRD

    L. Pieper, J. Klotsche, T. Eichler &  H.-U. Wittchen

  2. Universitätsklinikum Hamburg-Eppendorf, BRD

    H. Schulz

  3. Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Straße 46, 01187, Dresden, BRD

    H.-U. Wittchen

Authors
  1. L. Pieper
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  2. H. Schulz
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  3. J. Klotsche
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  4. T. Eichler
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  5. H.-U. Wittchen
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Corresponding author

Correspondence to H.-U. Wittchen.

Additional information

1 DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a cross-sectional and prospectivelongitudinal, nationwide clinical epidemiological study. DETECT is supported by an unrestricted educational grant of Pfizer GmbH, Karlsruhe, Germany. Principal investigator: Prof. Dr. H.-U. Wittchen; Staff members: Dipl.-Psych. L. Pieper, Dipl.-Psych. T. Eichler, Dipl.-Math. J. Klotsche, Dr. H. Glaesmer. Steering Committee: Prof. Dr. H. Lehnert (Coventry, UK), Prof. Dr. G.K. Stalla (München), Prof. Dr. M.A. Zeiher (Frankfurt); Advisory Board: Prof. Dr. W. März (Graz), Prof. Dr. S. Silber (München), Prof. Dr. Dr. U. Koch (Hamburg), PD Dr. D. Pittrow (München/Dresden), Professor Dr. M. Wehling (Mannheim).

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Pieper, L., Schulz, H., Klotsche, J. et al. Depression als komorbide Störung in der primärärztlichen Versorgung. Bundesgesundheitsbl. 51, 411–421 (2008). https://doi.org/10.1007/s00103-008-0509-6

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  • DOI: https://doi.org/10.1007/s00103-008-0509-6

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