Clarke David M, Cook Kay, Smith Graeme C, Piterman Leon
Monash University, Melbourne, VIC, Australia.
Med J Aust. 2008 Jun 16;188(S12):S110-3. doi: 10.5694/j.1326-5377.2008.tb01872.x.
To create a taxonomy of distress and depression for use in primary care, that mirrors the thinking and practice of experienced general practitioners.
Qualitative study, using an ethnomethodological approach, with observation of videotaped routine GP-patient consultations and in-depth interviews with GPs.
The study was conducted in metropolitan Melbourne in 2005. Fourteen GPs conducted 36 patient consultations where depression was a focus; nine GPs participated in in-depth interviews to elicit details of how they recognised and diagnosed depression in their patients.
GPs consider distress and depression in three steps. In the first step, a change in a group of symptoms and signs is observed (eg, facial expression, loss of drive). The second step categorises the syndrome according to whether or not there is an identifiable environmental cause (reactive or "endogenous"), with the final step categorising the reactive syndromes according to their most prominent symptoms: either anxiety and worry, or helplessness and hopelessness. The resulting taxonomy includes: endogenous depression (a chronic and perhaps characterological depression characterised by a lack of interest and motivation); anxious depressive reaction (stress or worry); and hopeless depressive reaction (demoralisation).
This simple and parsimonious taxonomy has validity based on its derivation from within the primary care setting.
创建一种用于初级保健的痛苦与抑郁分类法，以反映经验丰富的全科医生的思维与实践。
采用民族志方法的定性研究，观察全科医生与患者常规诊疗的录像，并对全科医生进行深入访谈。
该研究于2005年在墨尔本大都市地区进行。14名全科医生进行了36次以抑郁为重点的患者诊疗；9名全科医生参与深入访谈，以获取他们识别和诊断患者抑郁的详细情况。
全科医生分三步考量痛苦与抑郁。第一步，观察一组症状和体征的变化（如面部表情、动力丧失）。第二步，根据是否存在可识别的环境原因（反应性或“内源性”）对综合征进行分类，最后一步根据反应性综合征最突出的症状进行分类：焦虑和担忧，或无助和绝望。由此产生的分类法包括：内源性抑郁（一种以缺乏兴趣和动力为特征的慢性且可能是性格性的抑郁）；焦虑抑郁反应（压力或担忧）；以及绝望抑郁反应（士气低落）。
这种简单且简洁的分类法基于其源自初级保健环境而具有有效性。
