Brühl Karel G, Luijendijk Hendrika J, Muller Martien T
Geriant Foundation, DOC-team, Alkmaar, The Netherlands.
J Am Med Dir Assoc. 2007 Sep;8(7):441-5. doi: 10.1016/j.jamda.2007.05.010.
Recognition and treatment of depression is a quality indicator for nursing homes. Nurses and nursing assistants are in a particularly good position to recognize depression in long-term care. How well do nurses and nursing assistants recognize depression, compared with a DSM-IV diagnosis of depression? To answer this question a critical review of relevant literature in PubMed searches was performed.
It was found that nurses and nursing assistants recognize true depression in about 55% (sensitivity 42% to 78%) and "over-recognized" depression in about 40% of nondepressed patients (specificity 56% to 67%).
The prominent role of nurses and nursing assistants in daily mental health care is not reflected in the number of methodologically sound studies. Sensitivity of the Geriatric Depression Scale (GDS) is about 50% higher than nurses' recognition of depression. A specific recommendation for specially trained nursing assistants in depression management and standard use of screening scales in an update of the American Medical Directors Association's Clinical Practice Guideline on Depression might improve depression recognition, as well as nursing assistants' work satisfaction and staff turnover.
Recognition of depression by nurses and nursing assistants is low. Standard use of a screening scale like the GDS would improve recognition of depression in the elderly. More research is needed aimed at how nursing assistants can empower their role as mental health care provider in long-term care.
抑郁症的识别与治疗是养老院的一项质量指标。护士和护理助理在长期护理中处于特别有利的位置来识别抑郁症。与DSM-IV对抑郁症的诊断相比，护士和护理助理对抑郁症的识别情况如何？为回答这个问题，我们对PubMed搜索中的相关文献进行了批判性综述。
发现护士和护理助理识别出真正抑郁症的比例约为55%（敏感性为42%至78%），在约40%的非抑郁症患者中“过度识别”抑郁症（特异性为56%至67%）。
护士和护理助理在日常心理健康护理中的突出作用并未在方法学上合理的研究数量中得到体现。老年抑郁量表（GDS）的敏感性比护士对抑郁症的识别高出约50%。在美国医学主任协会关于抑郁症的临床实践指南更新中，针对经过专门培训的护理助理在抑郁症管理和筛查量表的标准使用方面提出具体建议，可能会提高抑郁症的识别率，以及护理助理的工作满意度和员工留用率。
护士和护理助理对抑郁症的识别率较低。像GDS这样的筛查量表的标准使用将提高对老年人抑郁症的识别率。需要更多研究关注护理助理如何在长期护理中增强其作为心理健康护理提供者的作用。
