Kratz Sandra, Härter Martin, Bermejo Isaac, Berger Mathias, Schneider Frank, Gaebel Wolfgang
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Düsseldorf, Rheinische Kliniken Düsseldorf.
Z Arztl Fortbild Qualitatssich. 2003 Nov;97 Suppl 4:50-6.
The present study investigates the extent to which the physicians' diagnosis of depression was influenced by the reason that patients gave for seeking help, i.e. the reason for encounter. The level of correspondence between the somatic diagnoses of 20 GPs and the self-ratings of 862 patients from the regions of North Rhine and Southern Baden in regard to the presence of a depressive syndrome was recorded. In addition to the somatic diagnosis of depression (yes/no), the reason for encounter as well as primary and secondary diagnoses of the participating GPs were also documented. The results show that approximately 10% of the GPs' patients judged themselves to be depressed and that in these patients, the GPs diagnosed depression in only 39% of cases. This low level of correspondence between physician and patient in regard to depression can be accounted for by the finding that first, there is little difference between depressed and non-depressed patients in the manner in which they distinguish themselves in regard to their reason for encounter and that second, depressed patients expressed more somatic (57%) than mental symptoms (20%). A depressive disorder was only reported for 5% of the patients who had judged themselves to be depressed. On the whole, the results have shown that the reasons for seeking treatment expressed by patients had a significant influence on correspondence between the physician and patient: for patients who had been judged by a physician and themselves to be depressed, mental complaints (34%) were more likely to be reported than for patients who had not been diagnosed with depression by their GPs (10%). Additional questions addressed to the physicians revealed that they were more likely to diagnose depression on the basis of the patients' self-ratings and behaviour than to routinely question the patients for symptoms of depression. Hence, the study underlines the need for training in criteria-orientated diagnosis and the application of suitable screening instruments for depressive disorders in general practice.
本研究调查了医生对抑郁症的诊断在多大程度上受到患者寻求帮助的原因（即就诊原因）的影响。记录了20名全科医生的躯体诊断与来自北莱茵地区和南巴登地区的862名患者关于抑郁综合征存在情况的自评之间的相符程度。除了抑郁症的躯体诊断（是/否）外，还记录了就诊原因以及参与研究的全科医生的主要和次要诊断。结果显示，约10%的全科医生的患者自评患有抑郁症，而在这些患者中，全科医生仅在39%的病例中诊断为抑郁症。医生与患者在抑郁症诊断上的低相符程度可归因于以下发现：第一，抑郁患者和非抑郁患者在区分就诊原因的方式上差异不大；第二，抑郁患者表达的躯体症状（57%）多于精神症状（20%）。在自评患有抑郁症的患者中，仅5%报告患有抑郁症。总体而言，结果表明患者表达的寻求治疗原因对医生与患者之间的相符程度有显著影响：对于被医生和患者本人均判定为抑郁的患者，与未被全科医生诊断为抑郁症的患者相比，更有可能报告精神方面的主诉（34%对10%）。向医生提出的其他问题显示，他们更倾向于根据患者的自评和行为来诊断抑郁症，而不是常规询问患者是否有抑郁症症状。因此，该研究强调了在全科医疗中进行基于标准的诊断培训以及应用合适的抑郁症筛查工具的必要性。
