Datto Catherine J, Thompson Richard, Knott Kathryn, Katz Ira R
Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Am Geriatr Soc. 2006 Apr;54(4):627-31. doi: 10.1111/j.1532-5415.2006.00660.x.
To evaluate patient reports of changes in depressive symptoms as information that can be used in treatment decision-making.
Longitudinal cohort study.
The Prevention of Suicide in Primary Care Elderly: Collaborative Trial and the Primary Care Research in Substance Abuse and Mental Health for the Elderly trial, multisite studies investigating the effect of depression interventions on outcomes in primary care.
Fifty-six patients aged 60 and older.
Patient demographics were collected from patient reports. Symptoms of depression were measured using the Centers for Epidemiologic Studies Depression Scale (CES-D) and Hamilton Depression Scale (HAM-D). Changes in depressive symptoms were also measured using the Clinical Global Impressions of Change (CGI-C) as rated by patients in ongoing treatment.
Patient ratings of CGI-C were significantly correlated with percentage improvement on the HAM-D as rated by the depression care manager (correlation coefficient (r)=0.44, P<.001) and percentage improvement on the CES-D (r=0.38, P=.005). The patient report of at least "much improved" predicted at least 50% treatment response based on HAM-D scale scores, with a sensitivity of 87.5% and a specificity of 74.2%.
These findings suggest that patients are able to accurately report their degree of improvement in depressive symptoms. Patient report of at least "much improved" can be used as an estimate of at least 50% depression treatment response. In an era of increasingly fragmented clinical care, these findings demonstrate that older adult primary care patients can accurately self-report overall change in depressive symptoms. When results of repeated depression instruments are not available, patient report of depression treatment response can be used to inform depression treatment decision-making.
评估患者关于抑郁症状变化的报告，作为可用于治疗决策的信息。
纵向队列研究。
初级保健老年人群自杀预防协作试验以及老年人群药物滥用和心理健康初级保健研究试验，这两项多中心研究调查了抑郁干预对初级保健结局的影响。
56名60岁及以上的患者。
从患者报告中收集患者人口统计学信息。使用流行病学研究中心抑郁量表（CES-D）和汉密尔顿抑郁量表（HAM-D）测量抑郁症状。还使用正在接受治疗的患者评定的临床总体印象变化量表（CGI-C）测量抑郁症状的变化。
患者对CGI-C的评定与抑郁护理经理评定的HAM-D改善百分比显著相关（相关系数（r）=0.44，P<0.001）以及与CES-D改善百分比显著相关（r=0.38，P=0.005）。基于HAM-D量表评分，患者报告至少“明显改善”可预测至少50%的治疗反应，敏感性为87.5%，特异性为74.2%。
这些发现表明患者能够准确报告其抑郁症状的改善程度。患者报告至少“明显改善”可作为至少50%抑郁治疗反应的估计。在临床护理日益碎片化的时代，这些发现表明老年初级保健患者能够准确自我报告抑郁症状的总体变化。当无法获得重复抑郁测评工具的结果时，患者关于抑郁治疗反应的报告可用于为抑郁治疗决策提供信息。
