Demyttenaere K, Enzlin P, Dewé W, Boulanger B, De Bie J, De Troyer W, Mesters P
Department of Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium.
J Clin Psychiatry. 2001;62 Suppl 22:34-7.
DSM-IV diagnosis of major depressive disorder includes a requirement that symptoms result in significant clinical distress or impairment. This criterion is difficult to assess and is often overlooked. This study examines the use of the Sheehan Disability Scale as a possible method of assessing impairment, as well as the relationship between functioning and discontinuation of antidepressant medication.
Patients (N = 272) receiving antidepressant therapy due to an episode of major depressive disorder were asked to complete an antidepressant compliance questionnaire. Patients were telephoned monthly while they continued on antidepressant therapy, up to 6 months. During each call, the Sheehan Disability Scale was administered.
Of patients referred to this study, 94.8% met DSM-IV criteria of at least 5 symptoms of major depressive disorder. Most patients had initial scores ranging from 5 to 8 on all 3 Sheehan disability subscales (occupational, social, and family functioning); 72% of patients had at least moderate impairment (scores > or = 4) on all 3 subscales. After 8 weeks of treatment, 42% of patients had scores < 4 on all 3 subscales (recovery); after 24 weeks, 64% of patients had scores < 4 on all 3 subscales. Dropout risk in men was related to improvement in occupational, social, and family functioning, whereas dropout risk in women was related only to improvement in family functioning.
The Sheehan Disability Scale can be valuable in assessing impairment and thus in correctly diagnosing major depressive disorder. We suggest that scores of 4 or more (moderate impairment) on all 3 subscales indicate sufficient impairment for a strict diagnosis of major depressive disorder. Functional symptoms continued to improve for up to 24 weeks on antidepressant therapy, suggesting 6 months or more of therapy is necessary for maximum functional improvement. Premature discontinuation of antidepressant therapy is more likely to occur in women who experience significant improvement in family functioning or men who experience significant improvement in any functional area.
《精神疾病诊断与统计手册》第四版（DSM-IV）中对重度抑郁症的诊断要求症状导致显著的临床痛苦或功能损害。这一标准难以评估且常被忽视。本研究考察了使用希恩残疾量表作为评估功能损害的一种可能方法，以及功能状况与抗抑郁药物停药之间的关系。
因重度抑郁发作而接受抗抑郁治疗的患者（N = 272）被要求完成一份抗抑郁药物依从性问卷。在患者持续接受抗抑郁治疗长达6个月期间，每月对其进行电话随访。每次随访时，使用希恩残疾量表。
本研究纳入的患者中，94.8%符合DSM-IV中至少有5项重度抑郁症状的标准。大多数患者在希恩残疾量表的所有3个分量表（职业、社交和家庭功能）上的初始得分在5至8分之间；72%的患者在所有3个分量表上至少有中度损害（得分≥4分）。治疗8周后，42%的患者在所有3个分量表上的得分<4分（恢复）；24周后，64%的患者在所有3个分量表上的得分<4分。男性的停药风险与职业、社交和家庭功能的改善有关，而女性的停药风险仅与家庭功能的改善有关。
希恩残疾量表在评估功能损害以及正确诊断重度抑郁症方面可能具有重要价值。我们建议，所有3个分量表的得分达到4分或更高（中度损害）表明存在足以作出重度抑郁症严格诊断的损害。在抗抑郁治疗中，功能症状持续改善长达24周，这表明为实现最大程度的功能改善，需要6个月或更长时间的治疗。抗抑郁治疗过早停药更可能发生在家庭功能有显著改善的女性或任何功能领域有显著改善的男性身上。
