Carney Colleen E, Ulmer Christi, Edinger Jack D, Krystal Andrew D, Knauss Faye
Department of Psychology, Ryerson University, 350 Victoria Street, JOR1037, Toronto, Ontario, Canada.
J Psychiatr Res. 2009 Feb;43(5):576-82. doi: 10.1016/j.jpsychires.2008.09.002. Epub 2008 Oct 26.
Due to concerns about overlapping symptomatology between medical conditions and depression, the validity of the beck depression inventory (BDI-II) has been assessed in various medical populations. Although major depressive disorder (MDD) and primary insomnia (PI) share some daytime symptoms, the BDI-II has not been evaluated for use with insomnia patients.
Participants (N=140) were screened for the presence of insomnia using the Duke structured clinical interview for sleep disorders (DSISD), and evaluated for diagnosis of MDD using the structured clinical interview for DSM-IV-TR (SCID). Participants' mean BDI-II item responses were compared across two groups [insomnia with or without MDD) using multivariate analysis of variance (MANOVA), and the accuracy rates of suggested clinical cutoffs for the BDI-II were evaluated using a receiver operating characteristic (ROC) curve analysis.
The insomnia with depression group had significantly higher scores on several items; however, the groups did not differ on insomnia, fatigue, concentration problems, irritability, libido, increased appetite, and thoughts relating to suicide, self-criticism and punishment items. The ROC curve analysis revealed moderate accuracy for the BDI-II's identification of depression in those with insomnia. The suggested BDI cutoff of >or=17 had 81% sensitivity and 79% specificity. Use of the mild cutoff for depression (>or=14) had high sensitivity (91%) but poor specificity (66%).
Several items on the BDI-II might reflect sleep disturbance symptoms rather than depression per se. The recommended BDI-II cutoffs in this population have some support but a lower cutoff could result in an overclassification of depression in insomnia patients, a documented problem in the clinical literature. Understanding which items discriminate insomnia patients without depression may help address this nosological issue.
由于担心躯体疾病与抑郁症之间存在重叠症状，贝克抑郁量表（BDI-II）在不同的医学人群中进行了效度评估。尽管重度抑郁症（MDD）和原发性失眠（PI）有一些共同的日间症状，但BDI-II尚未针对失眠患者进行评估。
使用杜克睡眠障碍结构化临床访谈（DSISD）对140名参与者进行失眠筛查，并使用DSM-IV-TR结构化临床访谈（SCID）评估MDD诊断。使用多变量方差分析（MANOVA）比较两组（有或无MDD的失眠患者）参与者的BDI-II项目平均反应，并使用受试者工作特征（ROC）曲线分析评估BDI-II建议临床临界值的准确率。
伴有抑郁症的失眠组在几个项目上得分显著更高；然而，两组在失眠、疲劳、注意力不集中、易怒、性欲、食欲增加以及与自杀、自我批评和惩罚相关的想法等项目上没有差异。ROC曲线分析显示，BDI-II对失眠患者中抑郁症的识别具有中等准确性。建议的BDI临界值≥17时，灵敏度为81%，特异度为79%。使用轻度抑郁症临界值（≥14）时灵敏度高（91%）但特异度低（66%）。
BDI-II中的几个项目可能反映的是睡眠障碍症状而非抑郁症本身。该人群中推荐的BDI-II临界值有一定依据，但较低的临界值可能会导致失眠患者中抑郁症的过度诊断，这是临床文献中已记载的问题。了解哪些项目能区分无抑郁症的失眠患者可能有助于解决这一分类学问题。
