Kahn Linda S, Fox Chester H, McIntyre Roger S, Tumiel-Berhalter Laurene, Berdine Diane E, Lyle Heather
State University of New York at Buffalo, USA.
Int J Psychiatry Med. 2008;38(1):13-29. doi: 10.2190/PM.38.1.b.
To determine the prevalence of self-reported depression symptoms among diabetic individuals enrolled in Gold Choice, a Medicaid managed care organization specifically for people with mental health and/or substance abuse diagnoses; and to assess the sensitivity and specificity of individuals' self-report with encounter data.
The 9-item depression scale of the Patient Health Questionnaire (PHQ-9) was mailed to 454 Gold Choice members in Western New York diagnosed with diabetes; and 249 completed PHQ-9 forms were returned (55% response rate). The PHQ-9 forms were compared to primary care encounter data to determine whether the respondents had been diagnosed with depression. Descriptive and inferential statistical analysis was undertaken.
The majority (56%) of individuals in the sample screened positive for depression (PHQ-9 > or = 10), and half (49%) did not have evidence of a diagnosis in their encounter data. The percentage of those diagnosed with depression rose with increasing PHQ-9 severity levels, with 63% of individuals with the most severe depression (PHQ-9 > or = 20) having a diagnosis. This trend was statistically significant, confirmed by independent sample t-tests and chi-square tests. The sensitivity of the PHQ-9 was moderate (66%), as was the specificity (52%).
The results of this study suggest that depressive disorders may be under-recognized and under-treated amongst individuals with diabetes in the primary care setting. Half (51%) of those with PHQ-9 scores > or = 10 had depression diagnoses, suggesting poor compliance rates and/or a need for therapy reassessment.
确定参加“黄金选择”计划（一个专门为有心理健康和/或药物滥用诊断的人群设立的医疗补助管理式医疗组织）的糖尿病患者中自我报告的抑郁症状的患病率；并评估个体自我报告与诊疗数据的敏感性和特异性。
将患者健康问卷（PHQ-9）的9项抑郁量表邮寄给纽约西部454名被诊断患有糖尿病的“黄金选择”计划成员；共收回249份填好的PHQ-9表格（回复率为55%）。将PHQ-9表格与初级保健诊疗数据进行比较，以确定受访者是否被诊断出患有抑郁症。进行了描述性和推断性统计分析。
样本中的大多数人（56%）抑郁筛查呈阳性（PHQ-9≥10），而其中一半（49%）在其诊疗数据中没有诊断证据。被诊断患有抑郁症的比例随着PHQ-9严重程度的增加而上升，最严重抑郁（PHQ-9≥20）的个体中有63%被诊断患有抑郁症。这一趋势具有统计学意义，经独立样本t检验和卡方检验证实。PHQ-9的敏感性中等（66%），特异性也为中等（52%）。
本研究结果表明，在初级保健环境中，糖尿病患者中的抑郁症可能未得到充分认识和治疗。PHQ-9评分≥10的患者中有一半（51%）被诊断患有抑郁症，这表明依从率较低和/或需要重新评估治疗方案。
