Picardi Angelo, Adler David A, Abeni Damiano, Chang Hong, Pasquini Paolo, Rogers William H, Bungay Kathleen M
Clinical Epidemiology Unit, Dermatological Institute IDI-IRCCS, Rome, Italy.
Acta Derm Venereol. 2005;85(5):414-9. doi: 10.1080/00015550510034966.
Despite being common, depression often goes undetected in patients with skin diseases. Our aim was to examine and compare the performance of three depression screeners. We studied dermatological inpatients aged 18-65 years. They completed the questionnaires Primary Care Screener for Affective Disorders (PC-SAD), Patient Health Questionnaire (PHQ) and General Health Questionnaire (GHQ-12) and were administered a standardized psychiatric interview (SCID-I) by a mental health professional, who was unaware of the questionnaire answers. The analysis was performed on 141 patients with complete data (79% of all eligible patients, 89% of all patients who agreed to participate). The prevalence of the main forms of depression, major depressive disorder and dysthymic disorder, was 8.4% and 6.3%, respectively. For major depressive disorder, the sensitivity and specificity of the questionnaires were as follows: PC-SAD, 73% and 88%; PHQ, 55% and 91%; GHQ-12, 73% and 78%. For dysthymic disorder, the sensitivity and specificity were as follows: PC-SAD, 56% and 95%; PHQ, 44% and 90%; GHQ-12, 56% and 76%. The small sample size suggests caution in drawing conclusions about the relative merits of these screeners. Although both the GHQ and the PHQ are short and easily hand scored, the first is a generic screener for psychiatric morbidity that is not specific for depression, while the second displayed modest sensitivity. The PC-SAD, with short average administration time, acceptable sensitivity and high specificity, might be particularly useful in settings where the technology for computer automated scoring is available. Although screening programmes might be useful, they should be supplemented by quality improvement programmes and by the development of consultation-liaison services.
尽管抑郁症很常见，但在皮肤病患者中往往未被发现。我们的目的是检查和比较三种抑郁症筛查工具的性能。我们研究了年龄在18至65岁之间的皮肤科住院患者。他们完成了情感障碍初级保健筛查问卷（PC-SAD）、患者健康问卷（PHQ）和一般健康问卷（GHQ-12），并由一名精神健康专业人员进行了标准化的精神科访谈（SCID-I），该专业人员不知道问卷答案。对141例有完整数据的患者进行了分析（占所有符合条件患者的79%，占所有同意参与患者的89%）。抑郁症的主要形式，即重度抑郁症和心境恶劣障碍的患病率分别为8.4%和6.3%。对于重度抑郁症，各问卷的敏感性和特异性如下：PC-SAD为73%和88%；PHQ为55%和91%；GHQ-12为73%和78%。对于心境恶劣障碍，敏感性和特异性如下：PC-SAD为56%和95%；PHQ为44%和90%；GHQ-12为56%和76%。样本量较小，因此在得出关于这些筛查工具相对优点的结论时应谨慎。虽然GHQ和PHQ都简短且易于人工计分，但前者是一种针对精神疾病的通用筛查工具，并非专门针对抑郁症，而后者的敏感性一般。PC-SAD平均施测时间短，敏感性可接受且特异性高，在具备计算机自动计分技术的环境中可能特别有用。尽管筛查项目可能有用，但应以质量改进项目和发展会诊联络服务作为补充。
