우울 경험, 진단 및 치료에 영향을 미치는 요인 = Factors Associated with Self-Reported Depression, Diagnosis, and Treatment among Korean Adults

다국어 초록 (Multilingual Abstract)

Background: We compared factors associated with self‐reported depression and, in particular, diagnosis andtreatment of depressive symptoms in Korean adults.
Methods: The sample included 13,306 adults aged 19 years or older from the 2010 and 2011 Korea NationalHealth and Nutrition Examination Survey (KNHANES Ⅴ). Data were applied to the χ 2 test and multivariate logisticregression analysis.
Results: The following characteristics of individuals are significantly associated with self-reported depression:female (vs. male, OR [odds ratio]=3.35), ages 50-59 years (vs. 60+, OR=1.45), economic status (low vs. high,OR=1.35; middle-low vs. high OR=1.29), unemployed (vs. employed, OR=1.23), education (elementary vs.
college, OR=1.18; middle school vs. college, OR=1.27; vs. high school vs. college, OR=1.18), current smoking (vs.
no, OR=1.19), high-risk alcohol consumption (vs. no, OR=1.18), perceived health (good vs. very good/excellent,OR=1.156; poor/fair vs. very good/excellent, OR=2.65), chronic disease (vs. no, OR=1.26), activity limitation dueto health problems (vs. no, OR=1.74), and being in a sickbed during the past month (vs. not in a sickbed, OR=1.69).
Living in a metropolitan area (vs. rural, OR=1.40) is significantly associated with greater odds of being diagnosedwith depression. The odds of being treated for depression are lower for female (vs. male, OR=0.53). Greater oddsof being treated for depression was seen for those with chronic conditions (vs. no, OR=1.73) and activity limitationdue to health problems (vs. no, OR=2.05), as well as, those in a sickbed (vs. not, OR=1.88).
Conclusions: Applying our findings, policy makers should address the lower rates of depression diagnosed innon-metropolitan areas to reduce regional variations, and also promote treatment in females.

국문 초록 (Abstract)

배경: 우울에 영향을 미치는 요인과 특히 우울의 진단및 치료에 영향을 미치는 사회인구학적, 건강행태, 건강상태 요인을 규명하여 비교 분석하고자 하였다.
방법: 2010년 및 2011년 국민건강영양조사 원시자료를이용하여 만 19세 이상 성인 13,306명을 분석대상으로 하였다. 교차분석 및 다중 로지스틱 회귀분석을 실시하였다.
결과: 다중 로지스틱 회귀분석 결과, 여성(여 vs. 남, OR(odds ratio)=3.35), 50대 연령(50-59 vs. 60+, OR=1.45),낮은 소득수준(하 vs. 상, OR=1.35; 중하 vs. 상, OR=1.29),무직(무 vs. 유, OR=1.23), 낮은 교육수준(초졸 vs. 대졸,OR=1.26; 중졸 vs. 대졸, OR=1.27; 고졸 vs. 대졸, OR=1.18),흡연(유 vs. 무, OR=1.19), 고위험음주(유 vs. 무, OR=2.28),낮은 주관적 건강(중 vs. 상, OR=1.52; 하 vs. 상, OR=2.65),만성질환(유 vs. 무, OR=1.255), 활동제한(유 vs. 무, OR=1.744),와병(유 vs. 무, OR=1.69) 등이 우울경험에 영향을 미치는 요인들이었다. 우울진단에 영향을 미치는 변수로는 거주지(대도시 vs. 군지역, OR=1.40)가 유일하였고, 남자일수록(여vs. 남, OR=0.501), 만성질환이 있을수록(OR=1.73), 활동제한이 있을수록(OR=2.05), 와병이 있을수록(OR=1.88) 우울치료를 받은 것으로 나타났다.
결론: 정책결정자는 우울증 진단율의 지역적 차이를 줄이기 위해 대도시 이외 지역에서의 우울진단율을 높이는한편 여성의 치료율을 향상시킬 수 있도록 노력해야 할것이다.

참고문헌 (Reference)

1 이경욱, "항우울제를 복용 중인 주요 우울증 환자에서 조기 치료 중단율과 위험 요인" 대한정신약물학회 17 (17): 550-556, 2006

2 김록범, "우울증상에 관련된 요인과 우울증상이 지각된 건강수준, 외래의료이용, 삶의 질에 미치는 영향" 한국보건교육건강증진학회 28 (28): 81-92, 2011

3 김지미, "노인의 우울과 건강수준과의 관련성" 한국노년학회 30 (30): 1311-1327, 2010

4 김영주, "남녀별 독거노인과 동거노인의 건강습관, 스트레스, 우울, 자살생각 비교" 기본간호학회 16 (16): 333-344, 2009

5 Narrow WE, "Use of services by persons with mental and addictive disorders:findings from the national institute of mental health epidemiologic catchment area program" 50 (50): 95-107, 1993

6 Yoon J, "The role of adverse physical health events on the utilization of mental health services" 48 (48): 175-194, 2013

7 Wells KB, "The functioning and well-being of depressed patients: results from the medical outcomes study" 262 (262): 914-919, 1989

8 Regier DA, "The de facto US mental and addictive disorders service system: epidemiologic catchment area prospective 1-year prevalence rates of disorders and services" 50 (50): 85-94, 1993

9 Hirschfeld RA, "Social functioning in depression:a review" 61 (61): 268-275, 2000

10 Grammatikopoulos L, "Social activity and participation as determinants of anxiety and depression among elderly in primary care" 9 (9): S137-, 2010

11 Cepoiu M, "Recognition of depression by non-psychiatric physicians-a systematic literature review and meta-analysis" 23 (23): 25-36, 2008

12 World Health organization, "Public health action for the prevention of suicide: a framework" WHO

13 Chiang HH, "Prevalence and correlates of depression among chronic kidney disease patients in Taiwan" 14 : 78-, 2013

14 Kessler RC, "Past-year use of outpatient services for psychiatric problems in the national comorbidity survey" 156 (156): 115-123, 1999

15 Centers for Disease Control and Prevention, "Mental illness surveillance among adults in the United States" MMWR

16 Chung JW, "Mental health resources in Korea" Ministry of Health and Welfare, Korea Institute for Health and Social Affairs

17 USDHHS, "Mental Health: a report of the Surgeon General. Washington" United States Department of Health and Human Services, Centers for Disease Control and Prevention, Office of the Surgeon General

18 World Health Organization, "Mental Health Atlas 2011" WHO

19 Zuckerbrot RA, "Improving recognition of adolescent depression in primary care" 160 (160): 694-704, 2006

20 Spitzer RL, "Health-related quality of life in primary care patients with mental disorders: results from the PRIMEMD 1000 study" 274 (274): 1511-1517, 1995

21 Wells KB, "Functioning and utility for current health of patients with depression or chronic medical conditions in managed, primary care practices" 56 (56): 897-904, 1999

22 Al-Nsour M, "Frequent mental distress, chronic conditions, and adverse health behaviors in the behavioral risk factor surveillance survey, Jordan, 2007" 10 : 130030-, 2013

23 Olfson M, "Continuity of antidepressant treatment for adults with depression in the United States" 163 (163): 101-108, 2006

24 Ministry of Health and Welfare, "2011 The epidemiological survey of mental disorders in Korea" Ministry of Health and Welfare, Seoul National University

25 Korea Centers for Disease Control and Prevention, "2011 Korean national health and nutrition examination survey" KCDC

26 Ministry of Health and Welfare, "2001 The Epidemiological survey of mental disorders in Korea" Ministry of Health and Welfare, Seoul National Hospita