Frank R G, Chaney J M, Clay D L, Shutty M S, Beck N C, Kay D R, Elliott T R, Grambling S
Department of Physical Medicine and Rehabilitation, University of Missouri-Columbia School of Medicine.
Psychiatry Res. 1992 Sep;43(3):231-41. doi: 10.1016/0165-1781(92)90056-9.
Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions. This study investigated the nature of depressive symptom criteria constellations by individually factor analyzing the Inventory to Diagnose Depression (based on DSM-III diagnostic criteria) in spinal cord injury (n = 134), rheumatoid arthritis (n = 78), student (n = 140), and community (n = 150) groups. A four-factor solution emerged, with the first factor labeled "dysphoria" being represented by symptoms of negative self-evaluations, depressed affect, and suicidal ideation. The results indicate that a core element of the syndrome of depression is dysphoria, which suggests that the contribution of somatic items may be less important to the identification of the depressive syndrome in chronic illness.
抑郁症常常在患有慢性疾病的人群中被诊断出来，或者在致残情况出现后被诊断出来。许多慢性疾病和致残状况的症状与抑郁症症状的重叠，可能导致在这类人群中对抑郁症的高估。一些研究人员在不了解诊断标准在致残状况中的作用的情况下，就提出了在这些情况下诊断抑郁症的修订标准。本研究通过对脊髓损伤组（n = 134）、类风湿性关节炎组（n = 78）、学生组（n = 140）和社区组（n = 150）分别对《抑郁症诊断量表》（基于《精神疾病诊断与统计手册》第三版诊断标准）进行因素分析，调查了抑郁症状标准组合的性质。出现了一个四因素解决方案，第一个因素被标记为“烦躁不安”，由负面自我评价、情绪低落和自杀观念等症状代表。结果表明，抑郁症综合征的一个核心要素是烦躁不安，这表明躯体项目对慢性疾病中抑郁综合征识别的贡献可能不那么重要。
