Grant Donna, Almond Michael K, Newnham Alison, Roberts Pauline, Hutchings Andrew
Department of General Adult Psychiatry, Brentwood, UK.
Nephron Clin Pract. 2008;110(1):c33-8. doi: 10.1159/000151230. Epub 2008 Aug 11.
There are high rates of mental illness, especially depression in people with end-stage renal disease (ESRD) on haemodialysis (HD). Depression can be difficult to diagnose, as depression and the medical problem share many symptoms. It is essential that the diagnosis of a depressive illness be accurately made in order that subsequent psychiatric management can occur. This is the first study done in the UK which aims to validate a simple method for detecting depression, the Beck Depression Inventory (BDI), in people on HD against a structured psychiatric interview with a trained psychiatrist using the ICD-10 classification of depression. The BDI is validated in a normal population, but in patients with physical ill health there has been a difficulty in defining appropriate cut-off scores.
Patients dialysing for over 3 months from a single HD unit were eligible for participation. Patients were excluded if a known psychiatric illness existed or if they were receiving medication for a psychiatric illness. Patients who had a recent major illness requiring hospitalisation were excluded. 57 consenting participants completed the self-reported BDI. Within the next week a psychiatrist carried out a clinical interview to diagnose depression, based on the ICD-10 classification of a depressive disorder. Patients were classified as not being depressed or having mild, moderate or severe depression according to their BDI score or the ICD-10 classification.
The BDI gave more scores for depression and more severe scores than ICD-10. 30 cases had scores which agreed, 27 cases resulted in a higher BDI score than the ICD-10 classification, in no case was the ICD-10 classification more severe (Wilcoxon signed rank test p < 0.001). All 7 diagnosed as being depressed by clinical interview were also depressed by BDI, although in 2 cases the BDI worsened the depression score.
Using the general population cut-off score, the BDI significantly overdiagnosed depression in this HD population. This study defines a BDI cut-off score which more reliably detects major depression in a HD population. Unrecognised depression remains high in those with no known psychiatric illness within the HD populations.
终末期肾病（ESRD）患者接受血液透析（HD）时，精神疾病尤其是抑郁症的发病率很高。抑郁症可能难以诊断，因为抑郁症和医疗问题有许多共同症状。准确诊断抑郁症至关重要，以便后续进行精神科治疗。这是英国首次开展的一项研究，旨在针对接受HD治疗的患者，通过与经过培训的精神科医生采用国际疾病分类第10版（ICD - 10）抑郁症分类进行的结构化精神科访谈，验证一种检测抑郁症的简单方法——贝克抑郁量表（BDI）。BDI在正常人群中得到了验证，但在身体健康欠佳的患者中，确定合适的临界值分数存在困难。
来自单个HD治疗单元且透析超过3个月的患者有资格参与。如果患者存在已知的精神疾病或正在接受精神疾病药物治疗，则被排除。近期有需要住院治疗的重大疾病的患者也被排除。57名同意参与的受试者完成了自我报告的BDI。在接下来的一周内，一名精神科医生根据ICD - 10抑郁症分类进行临床访谈以诊断抑郁症。根据患者的BDI分数或ICD - 10分类，将患者分为无抑郁、轻度抑郁、中度抑郁或重度抑郁。
BDI得出的抑郁分数和更严重分数比ICD - 10更多。30例病例的分数一致，27例病例的BDI分数高于ICD - 10分类，没有病例的ICD - 10分类更严重（Wilcoxon符号秩检验p < 0.001）。通过临床访谈诊断为抑郁的所有7例患者，BDI也显示为抑郁，尽管在2例病例中BDI使抑郁分数更高。
使用一般人群的临界值分数时，BDI在该HD人群中显著过度诊断了抑郁症。本研究确定了一个BDI临界值分数，该分数能更可靠地检测HD人群中的重度抑郁症。在HD人群中，无已知精神疾病的患者中未被识别的抑郁症患病率仍然很高。
