9項目の患者健康調査票を用いた中高年ホームレス成人の抑うつ症状の相関関係

Correlates of Depressive Symptoms among Middle-Aged and Older Homeless Adults Using the 9-Item Patient Health Questionnaire.

• Lin-Yun Wang
• Lan-Ping Lin
• Yun-Cheng Chen
• Tai-Wen Wang
• Jin-Ding Lin

抄録

本研究では、中高年ホームレスを対象に、Patient Health Questionnaire-9（PHQ-9）に基づいてうつ病症状のスクリーニングを行い、大うつ病症状に関連する可能性のある要因を検討した。調査対象は台北市万華区と台北駅の45歳以上のホームレス129名とした。分析のためのデータ収集には、ソーシャルワーカー3名による構造化質問紙と対面面接を用いた。質問紙の内容は、インフォームド・コンセント用紙、人口統計学的特徴、健康管理の可能性と必要性の要因、ホームレスのPHQ-9などであった。その結果、抑うつ症状がないと回答した人は15.5％、軽度レベル（スコア5～9）が16.3％、中等度レベル（スコア10～14）が31.8％、中等度レベル（スコア15～19）が26.4％、重度レベル（スコア20～27）が10.1％であった。PHQ-9スコア10を大うつ病症状のカットオフポイントとした場合、中高年ホームレスの68.3％は、近い将来、医療機関への再診が必要なケースであった。重回帰分析により、性別、年齢、精神科外来の利用が大うつ病症状の発生と関連していることが明らかになった。女性参加者は男性参加者よりも大うつ病症状を有する可能性が低かった（OR = 0.29、95％CI = 0.09-0.96）。高齢者の参加者は、45～54歳の参加者よりも大うつ病症状を有する可能性が高かった（OR＝5.29、95％CI＝1.44～19.41）。また、精神科外来を利用したことがある参加者は、大うつ病症状の発生と有意に相関していた（OR＝3.65、95％CI＝1.46-9.09）。本研究は、今後の健康政策において、ホームレス人口の健康とウェルビーイングを向上させるために、うつ病症状の危険因子を排除し、メンタルヘルスケアへのアクセスを改善すべきであることを示唆している。

This study investigates the screening for depressive symptoms among middle-aged and older homeless adults based on Patient Health Questionnaire-9 (PHQ-9) and examines the possible factors associated with their major depressive symptoms. A cross-sectional survey was employed, and research subjects included 129 homeless people aged 45 years old and over in Taipei Wanhua District and Taipei Main Station. We used a structured questionnaire and face-to-face interview conducted by three social workers to collect data in the analyses. The content of the questionnaire included an informed consent form, demographic characteristics, enabling and need factors of healthcare, and PHQ-9 of homeless people. Results revealed that 15.5% respondents were free of depressive symptoms, 16.3% had mild level (score 5-9), 31.8% had moderate level (score 10-14), 26.4% had moderately severe level (score 15-19), and 10.1% had severe level of depressive symptoms (score 20-27). Adopting a PHQ-9 score 10 as a cut-off point for major depressive symptoms, 68.3% of middle-aged and older homeless adults were the cases needing to be referred to healthcare settings for further recheck in the near future. A multiple regression analysis found gender, age, and usage of psychiatric outpatient care were associated with major depressive symptom occurrence. The female participants were less likely to have major depressive symptoms than the male participants (OR = 0.29, 95% CI = 0.09-0.96). The elderly participants were more likely to have major depressive symptoms than the aged 45-54 years (OR = 5.29, 95% CI = 1.44-19.41). Those participants who have ever used psychiatric outpatient care were significantly more correlated with the occurrence of major depressive symptoms than their counterparts (OR = 3.65, 95% CI = 1.46-9.09). The present study suggests that in the future health policy should eliminate the risk factors of depressive symptoms and improve mental healthcare access, to improve the health and wellbeing of the homeless population.