Davison Tanya E, McCabe Marita P, Mellor David
School of Psychology, Deakin University, Melbourne, Australia.
Am J Geriatr Psychiatry. 2009 May;17(5):359-67. doi: 10.1097/JGP.0b013e318190b901.
Individual clinical interviews are typically viewed as the "gold standard" when diagnosing major depressive disorder (MDD) and when examining the validity of self-rated questionnaires. However, this approach may be problematic with older people, who are known to underreport depressive symptomatology. This study examined the effect of including an informant interview on prevalence estimations of MDD in an aged-care sample.
The results of an individual clinical interview for MDD were compared with those obtained when an informant interview was incorporated into the assessment. Results from each diagnostic approach were compared with scores on a self-rated depression instrument.
Low-level aged-care residential facilities in Melbourne (equivalent to "residential homes," "homes for the elderly," or "assisted living facilities" in other countries).
One hundred and sixty-eight aged-care residents (mean age: 84.68 years; SD: 6.16 years) with normal cognitive functioning.
Individual clinical interviews were conducted using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders. This interview was modified for use with staff informants. Self-reported depression was measured using the Geriatric Depression Scale-15 (GDS-15).
The estimated point prevalence of MDD rose from 16% to 22% by including an informant clinical interview in the diagnostic procedure. Overall, 27% of depressed residents failed to disclose symptoms in the clinical interview. The concordance of the GDS-15 with a diagnosis of MDD was substantially lower when an informant source was included in the diagnostic procedure.
Individual interviews and self-report questionnaires may be insufficient to detect depression among older adults. This study supports the use of an informant interview as an adjunct when diagnosing MDD among cognitively intact aged-care residents.
在诊断重度抑郁症（MDD）以及检验自评问卷的效度时，个体临床访谈通常被视为“金标准”。然而，对于老年人而言，这种方法可能存在问题，因为众所周知他们会少报抑郁症状。本研究考察了纳入知情者访谈对老年护理样本中MDD患病率估计的影响。
将MDD个体临床访谈的结果与评估中纳入知情者访谈时获得的结果进行比较。将每种诊断方法的结果与自评抑郁量表的得分进行比较。
墨尔本的低级别老年护理居住设施（相当于其他国家的“养老院”“老人院”或“辅助生活设施”）。
168名认知功能正常的老年护理居民（平均年龄：84.68岁；标准差：6.16岁）。
使用《精神疾病诊断与统计手册》第四版轴I障碍的结构化临床访谈进行个体临床访谈。该访谈经修改后用于工作人员知情者。使用老年抑郁量表15项版（GDS - 15）测量自评抑郁情况。
在诊断过程中纳入知情者临床访谈后，MDD的估计时点患病率从16%升至22%。总体而言，27%的抑郁居民在临床访谈中未透露症状。当诊断过程中纳入知情者信息时，GDS - 15与MDD诊断的一致性显著降低。
个体访谈和自评问卷可能不足以检测出老年人中的抑郁症。本研究支持在对认知功能完好的老年护理居民进行MDD诊断时，使用知情者访谈作为辅助手段。
