Rogers William H, Wilson Ira B, Bungay Kathleen M, Cynn Diane J, Adler David A
The Health Institute, Division of Clinical Care Research, Department of Medicine, New England Medical Center (NEMC), 750 Washington Street, Box 345, Boston, MA 02111, USA.
J Clin Epidemiol. 2002 Feb;55(2):164-75. doi: 10.1016/s0895-4356(01)00430-9.
As many as 50% of patients with major depression seen in primary care settings are not diagnosed. To facilitate efficient identification of primary care patients with depression, we developed a new patient-administered depression screening instrument (PC-SAD) that produces a DSM-IV diagnosis, and compared its performance to other screeners that yield DSM-IV diagnoses. To assess validity, the diagnostic accuracy of the PC-SAD was compared with the Inventory to Diagnose Depression (IDD) and the PRIME-MD-PHQ (PHQ) in a convenience sample (N = 312) of health plan members, primary care outpatients, and psychiatric patients (with diagnoses). The screeners were compared with each other and with psychiatric diagnoses to assess their relative performance. Disagreement among the three screeners was formally tested using a triangulation approach that incorporates a statistical likelihood model. Of patients diagnosed as depressed using the IDD, 84.2% were also depressed by the PC-SAD (sensitivity). Of patients not diagnosed as depressed by the IDD, 94.7% were not depressed by the PC-SAD (specificity). Using the triangulation method the sensitivities were 87.2% (PC-SAD), 88.4% (IDD), and 60.7% (PHQ). The specificities were 95.0% (PC-SAD), 92.7% (IDD), and 98.3% (PHQ). The performance of the PC-SAD and the IDD was comparable. The PHQ was less sensitive than either of those. The PC-SAD respondent burden strikes a balance between the very short PHQ, and the longer IDD, and has the lowest (easiest) Flesch-Kincaid reading level. Investigators, clinicians, and health plans that want a DSM-IV-based depression screener can choose from among these three instruments, with known tradeoffs in sensitivity, respondent burden, and readability.
在初级保健机构中，多达50%的重度抑郁症患者未被诊断出来。为便于高效识别初级保健中的抑郁症患者，我们开发了一种新的患者自填式抑郁症筛查工具（PC-SAD），该工具可做出《精神疾病诊断与统计手册》第四版（DSM-IV）的诊断，并将其性能与其他能得出DSM-IV诊断结果的筛查工具进行比较。为评估有效性，在一个由健康计划成员、初级保健门诊患者和精神病患者（已确诊）组成的便利样本（N = 312）中，将PC-SAD的诊断准确性与抑郁症诊断量表（IDD）和PRIME-MD-患者健康问卷（PHQ）进行比较。将这些筛查工具相互比较，并与精神病诊断结果比较，以评估它们的相对性能。使用一种纳入统计似然模型的三角测量法，对这三种筛查工具之间的分歧进行了正式检验。使用IDD诊断为抑郁症的患者中，84.2%也被PC-SAD诊断为抑郁症（敏感性）。未被IDD诊断为抑郁症的患者中，94.7%也未被PC-SAD诊断为抑郁症（特异性）。使用三角测量法得出的敏感性分别为87.2%（PC-SAD）、88.4%（IDD）和60.7%（PHQ）。特异性分别为95.0%（PC-SAD）、92.7%（IDD）和98.3%（PHQ）。PC-SAD和IDD的性能相当。PHQ的敏感性低于这两者中的任何一个。PC-SAD给受访者带来的负担在非常简短的PHQ和较长的IDD之间达到了平衡，并且具有最低（最容易）的弗莱施-金凯德阅读难度等级。想要使用基于DSM-IV的抑郁症筛查工具的研究人员、临床医生和健康计划可以从这三种工具中进行选择，它们在敏感性、受访者负担和可读性方面存在已知的权衡。
