Ani Chizobam, Bazargan Mohsen, Hindman David, Bell Douglas, Farooq Muhammad A, Akhanjee Lutful, Yemofio Francis, Baker Richard, Rodriguez Michael
Family Medicine Department Charles R Drew University of Medicine and Science, 2594 Industryway, Lynwood, CA 90262, USA.
BMC Fam Pract. 2008 Jan 3;9:1. doi: 10.1186/1471-2296-9-1.
To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings.
Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community settings.
Of the 2321 participants screened for depression 304 were positive for depression and of these 75.3% (n = 229) were significantly depressed (PHQ-9 score > or = 10). Of these, 31.0% were diagnosed by a physician with a depressive disorder. A total of 57.6% (n = 175) of study participants had both significant depression symptoms and functional impairment. Of these 37.7% were diagnosed by physicians as depressed. Cohen's Kappa analysis, used to determine the agreement between depression symptoms elicited using the PHQ-9 and physician documentation of these symptoms showed only slight agreement (0.001-0.101) for all depression symptoms using standard agreement rating scales. Further analysis showed that only suicidal ideation and hypersomnia or insomnia were associated with an increased likelihood of physician depression diagnosis (OR 5.41 P sig < .01 and (OR 2.02 P sig < .05 respectively). Other depression symptoms and chronic medical conditions had no affect on physician depression diagnosis.
Two-thirds of individuals with depression are undiagnosed in primary care settings. While functional impairment increases the rate of physician diagnosis of depression, the agreement between a structured assessment and physician elicited and or documented symptoms during a clinical encounter is very low. Suicidality, hypersomnia and insomnia are associated with an increase in the rate of depression diagnosis even when physician and self report of the symptom differ. Interventions that emphasize the use of routine structured screening of primary care patients might also improve the rate of diagnosis of depression in these settings. Further studies are needed to explore depression symptom assessment during physician patient encounter in primary care settings.
使用一种评估工具（患者健康问卷-9，PHQ-9）来检查抑郁症状与医生在门诊就诊时对相同症状的记录之间的一致性，然后检查这些症状的存在如何影响初级保健环境中的抑郁症诊断。
由访员进行调查并审查病历。从两个大型城市初级保健社区环境中筛查抑郁症的2321名参与者中招募了总共304名参与者。
在2321名筛查抑郁症的参与者中，304名抑郁症呈阳性，其中75.3%（n = 229）有明显抑郁（PHQ-9评分≥10）。其中，31.0%被医生诊断为患有抑郁症。共有57.6%（n = 175）的研究参与者既有明显的抑郁症状又有功能损害。其中37.7%被医生诊断为抑郁。使用Cohen's Kappa分析来确定使用PHQ-9得出的抑郁症状与医生对这些症状的记录之间的一致性，使用标准一致性评定量表对所有抑郁症状显示只有轻微一致性（0.001 - 0.101）。进一步分析表明，只有自杀意念和睡眠过多或失眠与医生诊断抑郁症的可能性增加相关（分别为OR 5.41，P值<0.01和OR 2.02，P值<0.05）。其他抑郁症状和慢性疾病对医生诊断抑郁症没有影响。
在初级保健环境中，三分之二的抑郁症患者未被诊断出来。虽然功能损害会增加医生对抑郁症的诊断率，但结构化评估与医生在临床会诊时引出和/或记录的症状之间的一致性非常低。即使医生和自我报告的症状不同，自杀倾向、睡眠过多和失眠也与抑郁症诊断率的增加相关。强调对初级保健患者进行常规结构化筛查的干预措施可能也会提高这些环境中抑郁症的诊断率。需要进一步研究来探索初级保健环境中医生与患者会诊期间的抑郁症状评估。
