精神科門診憂鬱症患者就診率之變遷

Trends of Visiting Rate of Depressive Outpatients in Psychiatric Clinic

本研究旨在探討精神科門診憂鬱症個案，在就診人數、所佔門診比例、年齡、性別、以及診斷方面的長期變化，同時針對就診次數、就診期間長短、以及診斷與年齡等相關主題加以研究。選取西元1988年一月至西元2000年十二月某醫學中心精神科門診，符合ICD-9憂鬱症發作的初診個案共12350人，收集其性別、出生日期、就診日期、以及診斷等資料進行統計分析。全部納入研究之個案中女性8087人（65.5%），男性4263人（34.5%）；平均年齡為42.6（SD 17.2）歲；平均看診次數為9.8（SD 18.6）次。憂鬱症就診人數自1992年起逐年增加，而在憂鬱症佔所有精神科門診看診總人次比例方面，由1994年的14.5%，逐漸增加至2000年的27.3%。自1995年至2000年平均就診年齡有逐年下降的趨勢；在性別方面，每年憂鬱症看診之女性大約為男性的1.5至2.2倍；在診斷方面，精神官能性憂鬱症（Neurotic depression）的比例最高（50%-70%），而未分類之憂鬱症（Depressive disorder, not elsewhere classified）所佔百分比由1988年的38.3%減少為2000年的5.9%；在診斷與就診年齡方面，以未分類之憂鬱症（Depressive disorder, not elsewhere classified）的47.8（SD 18.5）歲為最高，而雙極性情感疾病，憂鬱期（Bipolar affective disorder, depressed）的37.1（SD 14.8）歲為最低；在就診次數方面，以雙極性情感疾病，憂鬱期（Bipolar affective disorder, depressed）的22.2（SD 33.7）次為最高，以短暫性憂鬱反應（Brief depressive reaction）的4.9（SD 10.9）次為最低。本研究結果發現在精神科門診過去十三年來，不但憂鬱症看診個案數有逐年增加的趨勢，並且在整體精神科就診比例上也有增加的現象，至於在就診年齡與診斷方面也有明顯的改變，因此未來在前瞻性的研究設計、以及跨部門的醫療整合等方面，都是值得進一步探討的層面，以發展更完備的憂鬱症專業醫療照護模式。

The present study sought to describe the longitudinal change of case number, rate in total psychiatric visiting, age, sex ratio, and diagnoses of depressive patients in psychiatric outpatient clinic. Besides, such related issues as number of visiting, interval of follow-up, and relationship between diagnoses and age were also investigated. A total of 12350 depressive cases that visited the psychiatric outpatient clinic of a medical center for the first time from January 1988 to December 2000 and met the ICD-9 criteria of depressive disorders were enrolled in this study. Data of sex, the date of birth, the date of visit, and diagnosis were collected and analyzed by statistical methods. The females were 8087(65.5%), and the males were 4263(34.5%). The mean age of first visiting was 42.6 (SD 17.2) years old, and the mean number of visiting was 9.8 (SD 18.6) times. Annual case number increased with time from 1992, and the rate of depression in total psychiatric outpatient visiting increased gradually from 14.5% of 1995 to 27.3% of 2000. The mean age of visiting decreased from 1995 to 2000. The sex ratio of female to male was ranged between 1.5 and 2.2. The number of neurotic depression cases ranked the highest every year, and the percentage of depressive disorder, NOS, decreased from 38.3% of 1988 to 5.9% of 2000. The mean age of depressive disorder, NOS, was 47.8 (SD 18.5) y/o, and that of bipolar affective disorder, depressed, was 37.1 (SD 14.8 y/o). The mean number of visiting of bipolar affective disorder, depressed, was 22.2 (SD 33.7), and that of brief depressive reaction, was 4.9 (SD 10.9). This study revealed that in the past thirteen years, the case number of depression increased with time, and the rate of depression in total psychiatric outpatient visiting also increased. In addition, obvious change of mean age and diagnosis was noted within the past thirteen years. Therefore, further prospective study and medical integration are warranted to be investigated to enhance the quality of professional care of depression.