Williams J W, Mulrow C D, Kroenke K, Dhanda R, Badgett R G, Omori D, Lee S
San Antonio Veterans Health Services Research Field Program, and Division of General Internal Medicine, University of Texas Health Science Center, USA.
Am J Med. 1999 Jan;106(1):36-43. doi: 10.1016/s0002-9343(98)00371-4.
Depression is a highly prevalent, morbid, and costly illness that is often unrecognized and inadequately treated. Because depression questionnaires have the potential to improve recognition, we evaluated the accuracy and effects on primary care of two case-finding instruments compared to usual care.
The study was conducted at three university-affiliated and one community-based medical clinics. Consecutive patients were randomly assigned to be asked a single question about mood, to fill out the 20-item Center for Epidemiologic Studies Depression Screen, or to usual care. Within 72 hours, patients were assessed for Diagnostic and Statistical Manual of Mental Disorders Third Revised Edition (DSM-III-R) disorders by an assessor blinded to the screening results. Process of care was assessed using chart audit and administrative databases; patient and physician satisfaction was assessed using Likert scales. At 3 months, depressed patients and a random sample of nondepressed patients were re-assessed for DSM-III-R disorders and symptom counts.
We approached 1,083 patients, of whom 969 consented to screening and were assigned to the single question (n = 330), 20-item questionnaire (n = 323), or usual care (n = 316). The interview for DSM-III-R diagnosis was completed in 863 (89%) patients; major depression, dysthymia, or minor depression was present in 13%. Both instruments were sensitive, but the 20-item questionnaire was more specific than the single question (75% vs 66%, P = 0.03). The 20-item questionnaire was less likely to be self-administered (54% vs 90%) and took significantly more time to complete (15 vs 248 seconds). Case-finding with the 20-item questionnaire or single question modestly increased depression recognition, 30/77 (39%) compared with 11/38 (29%) in usual care (P = 0.31) but did not affect treatment (45% vs 43%, P = 0.88). Effects on DSM-III-R symptoms were mixed. Recovery from depression was more likely in the case-finding than usual care groups, 32/67 (48%) versus 8/30 (27%, P = 0.03), but the mean improvement in depression symptoms did not differ significantly (1.6 vs 1.5 symptoms, P = 0.21).
A simple question about depression has similar performance characteristics as a longer 20-item questionnaire and is more feasible because of its brevity. Case-finding leads to a modest increase in recognition rates, but does not have consistently positive effects on patient outcomes.
抑郁症是一种高度流行、病态且代价高昂的疾病，常常未被识别且治疗不充分。由于抑郁症调查问卷有可能提高识别率，我们评估了两种病例发现工具相对于常规护理的准确性及其对初级保健的影响。
该研究在三所大学附属医院和一所社区诊所进行。连续的患者被随机分配，要么被询问一个关于情绪的问题，要么填写一份包含20个条目的流行病学研究中心抑郁筛查量表，要么接受常规护理。在72小时内，由对筛查结果不知情的评估者对患者进行《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）疾病评估。使用病历审查和管理数据库评估护理过程；使用李克特量表评估患者和医生的满意度。在3个月时，对抑郁症患者和非抑郁症患者的随机样本再次进行DSM-III-R疾病和症状计数评估。
我们接触了1083名患者，其中969名同意接受筛查，并被分配到单问题组（n = 330）、20条目问卷组（n = 323）或常规护理组（n = 316）。863名（89%）患者完成了DSM-III-R诊断访谈；重度抑郁症、心境恶劣或轻度抑郁症的患病率为13%。两种工具都很敏感，但20条目问卷比单问题更具特异性（75%对66%，P = 0.03）。20条目问卷不太可能由患者自行填写（54%对90%），且完成所需时间显著更长（15秒对248秒）。使用20条目问卷或单问题进行病例发现适度提高了抑郁症的识别率，分别为30/77（39%），而常规护理组为11/38（29%）（P = 0.31），但对治疗没有影响（45%对43%，P = 0.88）。对DSM-III-R症状的影响不一。病例发现组比常规护理组更有可能从抑郁症中康复，分别为32/67（48%）对8/30（27%，P = 0.03），但抑郁症症状的平均改善没有显著差异（1.6个症状对1.5个症状，P = 0.21）。
一个关于抑郁症的简单问题与一份更长的20条目问卷具有相似的性能特征，且因其简短性而更可行。病例发现导致识别率适度提高，但对患者结局并没有始终产生积极影响。
