Zimmerman Mark, McGlinchey Joseph B, Young Diane, Chelminski Iwona
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA.
J Nerv Ment Dis. 2006 Mar;194(3):158-63. doi: 10.1097/01.nmd.0000202239.20315.16.
The diagnostic criteria for depression were developed on the basis of clinical experience rather than empirical study. Although they have been available and widely used for many years, few studies have examined the psychometric properties of the DSM criteria for major depression. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we examined whether criteria such as insomnia, fatigue, and impaired concentration that are also diagnostic criteria for other disorders are less specific than the other DSM-IV depression symptom criteria. We also conducted a regression analysis to determine whether all criteria are independently associated with the diagnosis of major depressive disorder. A total of 1538 psychiatric outpatients were administered a semistructured diagnostic interview. We inquired about all of the symptoms of depression for all patients. All of the DSM-IV symptom criteria for major depressive disorder were significantly associated with the diagnosis. Contrary to our prediction, symptoms such as insomnia, fatigue, and impaired concentration, which are also criteria of other disorders, generally performed as well as the criteria that are unique to depression such as suicidality, worthlessness, and guilt. The results of the regression analysis, which controlled for symptom covariation, indicated that five symptoms (increased weight, decreased weight, psychomotor retardation, indecisiveness, and suicidal thoughts) were not independently associated with the diagnosis of depression. The implications of these results for revising the diagnostic criteria for major depression are discussed.
抑郁症的诊断标准是基于临床经验而非实证研究制定的。尽管这些标准已经存在并被广泛使用多年，但很少有研究考察过《精神疾病诊断与统计手册》（DSM）中重度抑郁症标准的心理测量特性。在罗德岛改善诊断评估与服务方法项目的本报告中，我们研究了诸如失眠、疲劳和注意力不集中等也是其他疾病诊断标准的症状，是否比DSM-IV中其他抑郁症症状标准的特异性更低。我们还进行了回归分析，以确定所有标准是否都与重度抑郁症的诊断独立相关。总共1538名精神科门诊患者接受了半结构化诊断访谈。我们询问了所有患者的所有抑郁症状。DSM-IV中所有重度抑郁症的症状标准都与诊断显著相关。与我们的预测相反，诸如失眠、疲劳和注意力不集中等也是其他疾病标准的症状，通常与抑郁症特有的标准（如自杀倾向、无价值感和内疚感）表现相当。控制了症状共变的回归分析结果表明，五个症状（体重增加、体重减轻、精神运动迟缓、犹豫不决和自杀念头）与抑郁症的诊断并非独立相关。本文讨论了这些结果对修订重度抑郁症诊断标准所具有的意义。
