Konak 02 No'lu Kahramanlar Aile Sağlığı Merkezine başvuran 18 yaş ve üzeri kişilerde depresif belirti, intihar düşüncesi sıklığı ve ilişkili etmenler
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Dosyalar
Tarih
2022
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Depresyonda olanlar ve intihar düşüncesine sahip olan hastalar birinci basamak sağlık kuruluşlarına sıkça başvurmaktadırlar. Birinci basamak sağlık kuruluşları, depresif hastalar ve intihar düşüncesine sahip olan hastalar için ilk temas noktası olduğundan erken tanı ve tedavide kilit bir role sahiptir. Kesitsel tasarımda olan bu çalışma ile Konak 2 No’lu Kahramanlar Aile Sağlığı Merkezi’ne başvuran 18 yaş ve üstü bireylerde depresif belirti, intihar düşüncesi sıklığı ve ilişkili etmenleri belirlemek amaçlanmıştır. Gereç ve yöntem: Araştırma kapsamında İzmir İli Konak 2 No’lu Kahramanlar Aile Sağlığı Merkezi’ne 05.04.2021-04.06.2021 tarihleri arasında başvuran 862 kişi ile görüşülmüş, evreni bilinmeyen örneklem hesaplamasıyla sayısı belirlenmiş olan ve dahil edilme kriterlerine uyan, çalışmaya katılmayı kabul eden 507 katılımcı araştırmaya dahil edilmiştir. Araştırmanın bağımlı değişkenleri depresif belirti ve intihar düşüncesidir. Depresif belirti Kroenke, Spitzer ve Williams tarafından 2001 yılında geliştirilen ve 2016 yılında Yunus Emre Sarı ve arkadaşları tarafından Türkçeye uyarlanan Hasta Sağlık Anketi-9 (PHQ-9) ölçeği ile belirlenmiştir. İntihar düşüncesi literatüre uygun olarak Hasta Sağlık Anketi-9 (PHQ-9) ‘un 9. son sorusu olan “Ölmüş olsanız daha iyi olacağınız veya bir şekilde kendinize zarar verme düşünceleri” sorusuyla belirlenmiştir. Bağımsız değişkenler dört grupta toplanmıştır; sosyo-demografik faktörler, sağlıkla ve alışkanlıklarla ilgili faktörler, ruh sağlığıyla ilgili faktörler, pandemi ile ilgili faktörler. Veriler, oluşturulan anket formu aracılığıyla 05.04.2021-04.06.2021 tarihleri arasında yüzyüze toplanmıştır. Tanımlayıcı analizler ortalamalar, sayı, yüzde olarak hesaplanırken depresif belirti, intihar düşüncesi ile bağımsız değişkenler arasındaki ilişkiyi göstermek için iki değişkenli analizlerde ki-kare ve Student’s t testi, çok değişkenli analizlerde lojistik regresyon kullanılmıştır. Veri analizinde SPSS 23.0 istatistik programı kullanılmıştır. İstatistiksel anlamlılık p<0,05 olarak kabul edilmiştir. Bulgular: Araştırmada örneklem sayısı olarak belirlenmiş 507 kişi sayısına ulaşılmıştır. Katılımcıların %56,6’sı kadın, %43,4’ü erkektir ve ortalama yaşı 44,38±15,31’dir. 10 kesme puanına göre katılımcıların %24,5’inde majör depresyon düzeyinde depresif belirtiler görüldü. Katılımcıların %13’ü ise son 15 gün içinde intihar düşüncesi yaşadığını belirtmiştir. Katılımcıların Yaygın Anksiyete Bozukluğu-7 (YAB-7) ölçeğinden aldığı puanlara göre % 19,9’ unda yaygın anksiyete bozukluğu belirtileri görüldü. Depresyon bağımlı değişken olarak alındığında yapılan çok değişkenli analizlerde, 25-44 yaş grubunda olanların 45-64 yaş grubunda olanlara göre 3,25 kat (%95 GA: 1,49 – 7,06), 65 yaş ve üzeri yaş grubunda olanların 45-64 yaş grubunda olanlara göre 3,50 kat (%95 GA: 1,12 – 10,91), geliri giderinden daha az gelir algısına sahip olanların eşit-fazla gelir algısına sahip olanlara göre 3,07 kat (%95 GA: 1,44 – 6,51), yaşamı boyunca intihar düşüncesi yaşamış olanların bu düşünceyi yaşamamış olanlara göre 2,55 kat (%95 GA: 1,21 – 5,37), COVİD-19 pandemisi nedeniyle bir yakınını kaybetmiş olanların kaybetmemişlere göre 3,15 kat (%95 GA: 1,44 – 6,91), pandemi nedeniyle işini kaybedenlerin kaybetmeyenlere göre 3,37 kat (%95 GA: 1,03 – 10,93), pandemi döneminde ruh sağlığı kötü yönde değişenlerin aynı-iyi grubuna göre 3,37 kat (%95 GA: 1,03 – 10,93) depresyonda olma riskinin arttığı gösterilmiştir. Yaygın Anksiyete Bozukluğu-7 (YAB-7) Ölçeği skorundaki her bir puan artışın depresyonda olma riskini 1,27 kat (%95 GA: 1,19 – 1,37) arttırdığı gösterilmiştir. İntihar düşüncesi bağımlı değişken olarak alındığında yapılan çok değişkenli analizlerde COVİD-19 pandemisi sebebiyle işini kaybedenlerin kaybetmeyenlere göre 5,85 kat (%95 GA: 1,62-21,07), daha önce depresyon tanısı alanların almayanlara göre 6,02 kat (%95 GA: 1,93-18,73), daha önce depresyon dışı bir ruh sağlığı bozukluğu tanısı alanların almayanlara göre 4,21 kat (%95 GA: 1,27-13,97), yaşam boyu intihar düşüncesine sahip olanların olmayanlara göre 5,24 kat (%95 GA: 1,86-14,74), sağlık algısı kötü-çok kötü olanların çok iyi-iyi-normal olanlara göre 9,83 kat (%95 GA: 1,65-58,46) intihar düşüncesi riskinin arttığı gösterilmiştir. YAB -7 Ölçeği skoru ve Hasta Sağlık Anketi-8 (PHQ-8) Ölçeği skorundaki her bir puanlık artışın intihar düşüncesi riskini sırasıyla 1,11 kat (%95 GA: 1,00-1,25) ve 1,20 kat (%95 GA: 1,08-1,35) arttırdığı gösterilmiştir. Sonuç: Araştırma grubunda yaklaşık olarak her dört katılımcıdan birinin depresyonda olduğu, sekiz katılımcıdan birinin intihar düşüncesi olduğu belirlenmiştir. Bu sonuçlar depresyon ve intihar düşüncesinin birinci basamak sağlık kuruluşlarına başvuranlarda sıklığının yüksek olduğunu ve bu sıklığı COVİD-19 pandemisinin ve etkilerinin de ayrıca arttırdığını gösteren önceki çalışmaları doğrulamaktadır. Bu iki büyük halk sağlığı sorununu çözmek için öncelikle risk altındaki kişileri belirlemeye yönelik tarama programları uygulanmalı ve risk faktörlerine yönelik hizmetlerin birinci basamak sağlık kuruluşlarına entegrasyonu sağlanmalı ve toplum tabanlı ruh sağlığı müdahaleleri eklenmelidir.
Introduction and aim: Patients with depression and suicidal ideation frequently apply to primary health care institutions. Primary care facilities are the first point of contact for depressed patients and patients with suicidal ideations and therefore play a key role in early diagnosis and treatment. With this cross-sectional study, it was aimed to determine the frequency of depressive symptoms, suicidal ideation and related factors in individuals aged 18 and over who applied to Konak No. 2 Kahramanlar Family Health Center Materials and methods: Within the scope of the research 862 people who applied to İzmir Province Konak No. 2 Kahramanlar Family Health Center between 05.04.2021 and 04.06.2021 were interviewed and 507 participants were included to reach the target population size determined by the calculation of the unknown universe were included in the study. Dependent variables of the study are depressive symptoms and suicidal ideation. Depressive symptoms were determined by the Patient Health Questionnaire-9 (PHQ-9) scale developed by Kroenke, Spitzer and Williams in 2001 and adapted into Turkish by Yunus Emre Sarı et al. in 2016. Suicidal ideation was determined by the 9th last question of the Patient Health Questionnaire-9 (PHQ-9), “Thoughts that you would be better off dead or of hurting yourself in some way”. Independent variables were collected in four groups; socio-demographic factors, factors related to the health and habits, factors related to mental health, factors related to the pandemic. The data were collected face to face between 05.04.2021 and 04.06.2021 through the questionnaire developed. While descriptive analyzes were calculated as means, number, percentage; Chi-square and Student's t tests were used in bivariate analyzes to show the relationship between depression and suicidal ideation and independent variables. Logistic regression was used in multivariate analyses. SPSS 23,0 program was used in data analysis. Statistical significance was accepted as p<0,05. Results: In the study, the target sample size of 507 people was reached. Among the the participants, 56.6% were female and 43.4% were male, and their average age was 44.38±15.31. According to the 10 cut-off point of points, 24.5% of the participants had depressive symptoms at the level of major depression. Among respondents, 13.0% of the respondents reported experiencing suicidal ideations in the last 15 days. According to the scores of the participants from the Generalized Anxiety Disorder-7 (GAD-7) scale, 19.9% of the participants had generalized anxiety disorder symptoms. In multivariate analyzes when depression was the dependent variable, the risk of being depressed was 3.25 times (95% CI: 1.49 – 7.06) elevated in the 25-44 age group compared to the 45-64 age group and 3.50 times (%95 GA: 1.12 – 10.91) elevated in the age group of 65 and over compared to the 45-64 age group, 3.07 times (95% GA: 1.44 – 6.51%) elevated among respondents with a perciered income less than expenses compared to those who answered equally- more than income, 2.55 times (95% CI: 1.21 – 5.37) elevated among participans having a lifetime history of suicidal ideation compared to not having had this thought, 3.15 times (95% GA: 1,44 – 6,91%) elevated among respondents losing a relative due to the COVİD-19 pandemic compared to those who had not lost a relative, 3.37 times (95% CI: 1,03 – 10,93) elevated among participans losing a job due to the COVİD-19 pandemic compared to not losing a job, 3.37 times (95% CI: 1,03 – 10,93) elevated poor mental health during the pandemic compared to being unchanged or well. It has been shown that each increase in the Generalized Anxiety Disorder-7 (GAD-7) Scale score increases the risk of being depressed 1.27 times (95% CI: 1.19 - 1.37. In multivariate analyzes when suicidal ideation was the dependent variable, the risk of having suicidal ideation was 5,85 times (95% CI: 1,62 – 21,07) elevated in participants losing a job due to the COVİD-19 pandemic compared to not losing a job, 6,02 times (95% CI: 1,93-18,73) elevated among the ones having previously been diagnosed with depression compared to not having it, 4,21 times (95% CI: 1,27-13,97) elevated in patients having been diagnosed with a non-depressive mental health disorder in the past compared to not having it, 5,24 times (95% CI: 1,86 – 14,74) elevated having a lifetime history of suicidal ideation compared to not having had this thought, 9,83 times (95% GA: 1,65-58,46) elevated among participans with bad-very bad health perception compared to those with very good-good-normal ones. Each point increase in the GAD -7 Scale score and the Patient Health Questionnaire-8 (PHQ-8) Scale has been shownty increased the risk of suicidal idation by 1.11 times (95% CI: 1.00-1.25) and 1.20 times (95% CI: 1.08–1.35) respectively. Conclusions: Approximately one in four participants in the research group was found to be depressed, and one in eight had suicidal thoughts. These results confirm previous studies showing that depression and suicidal thoughts are high in the primary health care providers and that the COVİD-19 pandemic and its effects might also have increased this frequency. To solve these two major public health problems, screening programs have to identify at-risk people and integration of services for risk factors into primary health care should be ensured and community-based mental health interventions should be added.
Introduction and aim: Patients with depression and suicidal ideation frequently apply to primary health care institutions. Primary care facilities are the first point of contact for depressed patients and patients with suicidal ideations and therefore play a key role in early diagnosis and treatment. With this cross-sectional study, it was aimed to determine the frequency of depressive symptoms, suicidal ideation and related factors in individuals aged 18 and over who applied to Konak No. 2 Kahramanlar Family Health Center Materials and methods: Within the scope of the research 862 people who applied to İzmir Province Konak No. 2 Kahramanlar Family Health Center between 05.04.2021 and 04.06.2021 were interviewed and 507 participants were included to reach the target population size determined by the calculation of the unknown universe were included in the study. Dependent variables of the study are depressive symptoms and suicidal ideation. Depressive symptoms were determined by the Patient Health Questionnaire-9 (PHQ-9) scale developed by Kroenke, Spitzer and Williams in 2001 and adapted into Turkish by Yunus Emre Sarı et al. in 2016. Suicidal ideation was determined by the 9th last question of the Patient Health Questionnaire-9 (PHQ-9), “Thoughts that you would be better off dead or of hurting yourself in some way”. Independent variables were collected in four groups; socio-demographic factors, factors related to the health and habits, factors related to mental health, factors related to the pandemic. The data were collected face to face between 05.04.2021 and 04.06.2021 through the questionnaire developed. While descriptive analyzes were calculated as means, number, percentage; Chi-square and Student's t tests were used in bivariate analyzes to show the relationship between depression and suicidal ideation and independent variables. Logistic regression was used in multivariate analyses. SPSS 23,0 program was used in data analysis. Statistical significance was accepted as p<0,05. Results: In the study, the target sample size of 507 people was reached. Among the the participants, 56.6% were female and 43.4% were male, and their average age was 44.38±15.31. According to the 10 cut-off point of points, 24.5% of the participants had depressive symptoms at the level of major depression. Among respondents, 13.0% of the respondents reported experiencing suicidal ideations in the last 15 days. According to the scores of the participants from the Generalized Anxiety Disorder-7 (GAD-7) scale, 19.9% of the participants had generalized anxiety disorder symptoms. In multivariate analyzes when depression was the dependent variable, the risk of being depressed was 3.25 times (95% CI: 1.49 – 7.06) elevated in the 25-44 age group compared to the 45-64 age group and 3.50 times (%95 GA: 1.12 – 10.91) elevated in the age group of 65 and over compared to the 45-64 age group, 3.07 times (95% GA: 1.44 – 6.51%) elevated among respondents with a perciered income less than expenses compared to those who answered equally- more than income, 2.55 times (95% CI: 1.21 – 5.37) elevated among participans having a lifetime history of suicidal ideation compared to not having had this thought, 3.15 times (95% GA: 1,44 – 6,91%) elevated among respondents losing a relative due to the COVİD-19 pandemic compared to those who had not lost a relative, 3.37 times (95% CI: 1,03 – 10,93) elevated among participans losing a job due to the COVİD-19 pandemic compared to not losing a job, 3.37 times (95% CI: 1,03 – 10,93) elevated poor mental health during the pandemic compared to being unchanged or well. It has been shown that each increase in the Generalized Anxiety Disorder-7 (GAD-7) Scale score increases the risk of being depressed 1.27 times (95% CI: 1.19 - 1.37. In multivariate analyzes when suicidal ideation was the dependent variable, the risk of having suicidal ideation was 5,85 times (95% CI: 1,62 – 21,07) elevated in participants losing a job due to the COVİD-19 pandemic compared to not losing a job, 6,02 times (95% CI: 1,93-18,73) elevated among the ones having previously been diagnosed with depression compared to not having it, 4,21 times (95% CI: 1,27-13,97) elevated in patients having been diagnosed with a non-depressive mental health disorder in the past compared to not having it, 5,24 times (95% CI: 1,86 – 14,74) elevated having a lifetime history of suicidal ideation compared to not having had this thought, 9,83 times (95% GA: 1,65-58,46) elevated among participans with bad-very bad health perception compared to those with very good-good-normal ones. Each point increase in the GAD -7 Scale score and the Patient Health Questionnaire-8 (PHQ-8) Scale has been shownty increased the risk of suicidal idation by 1.11 times (95% CI: 1.00-1.25) and 1.20 times (95% CI: 1.08–1.35) respectively. Conclusions: Approximately one in four participants in the research group was found to be depressed, and one in eight had suicidal thoughts. These results confirm previous studies showing that depression and suicidal thoughts are high in the primary health care providers and that the COVİD-19 pandemic and its effects might also have increased this frequency. To solve these two major public health problems, screening programs have to identify at-risk people and integration of services for risk factors into primary health care should be ensured and community-based mental health interventions should be added.
Açıklama
Anahtar Kelimeler
Depresyon, İntihar Düşüncesi, Birinci Basamak Sağlık Hizmetleri, Halk Sağlığı, Depression, Suicidal Ideation, Primary Health Care, Public Health
