Terluin Berend, van Hout Hein P J, van Marwijk Harm W J, Adèr Herman J, van der Meer Klaas, de Haan Marten, van Dyck Richard
Department of General Practice, Institute for Research in Extramural Medicine, VU Medical Center, Amsterdam, The Netherlands.
Gen Hosp Psychiatry. 2002 Nov-Dec;24(6):396-405. doi: 10.1016/s0163-8343(02)00211-6.
General practitioners (GPs) are recommended to use DSM-IV criteria to diagnose major depression in daily clinical practice. This implies the assessment of nine depressive symptoms and four additional criteria. A short structured interview has been developed to assess these symptoms and criteria, and a study was carried out to investigate the reliability and validity with which GPs can assess these symptoms and criteria and the DSM-IV diagnosis of major depression. In 14 general practices, 52 patients with symptoms of distress and depression were interviewed twice by their GP, with an interval of one to four days. Furthermore, the patients filled out three depression questionnaires. The reproducibility of eight symptoms and three additional criteria was moderate to good (kappa >0.40). The reproducibility of the depressive symptom count, that is necessary to arrive at a diagnosis of major depression, was such that in 75 percent of the patients the test-retest difference did not exceed one symptom. The reproducibility of the diagnosis of major depression was good (kappa 0.63). The validity of the diagnosis of major depression assessed by the GPs, as compared to results of the self-report depression questionnaires, was satisfactory (r 0.35-0.61). Diagnosing major depression in patients with depressive symptomatology just above or below the threshold of major depression warrants a certain amount of caution in general practice.
建议全科医生（GPs）在日常临床实践中使用《精神疾病诊断与统计手册》第四版（DSM-IV）标准来诊断重度抑郁症。这意味着要评估九种抑郁症状和另外四条标准。现已开发出一种简短的结构化访谈来评估这些症状和标准，并开展了一项研究，以调查全科医生评估这些症状、标准以及重度抑郁症的DSM-IV诊断的可靠性和有效性。在14家全科诊所中，52名有痛苦和抑郁症状的患者由其全科医生进行了两次访谈，间隔时间为1至4天。此外，患者还填写了三份抑郁问卷。八种症状和三条附加标准的可重复性为中等至良好（kappa>0.40）。得出重度抑郁症诊断所需的抑郁症状计数的可重复性表明，75%的患者重测差异不超过一种症状。重度抑郁症诊断的可重复性良好（kappa 0.63）。与自我报告抑郁问卷的结果相比，全科医生评估的重度抑郁症诊断的有效性令人满意（r 0.35 - 0.61）。在日常实践中，对抑郁症状略高于或略低于重度抑郁症阈值的患者进行重度抑郁症诊断时需要一定的谨慎。
