Akechi Tatsuo, Ietsugu Tetsuji, Sukigara Masune, Okamura Hitoshi, Nakano Tomohito, Akizuki Nobuya, Okamura Masako, Shimizu Ken, Okuyama Toru, Furukawa Toshiaki A, Uchitomi Yosuke
Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
Gen Hosp Psychiatry. 2009 May-Jun;31(3):225-32. doi: 10.1016/j.genhosppsych.2008.12.004. Epub 2009 Feb 1.
The objective of this study was to explore the performances of several diagnostic criteria items for judging the severity of major depression among cancer patients.
Using modern item response theory, we examined the performances of the diagnostic criteria outlined by the DSM-IV and two sets of conceptual diagnostic criteria (the Endicott and the Cavanaugh criteria) in a series of 728 cancer patients who had been diagnosed with major depression using an inclusive approach.
While all the DSM-IV diagnostic criteria, including feelings of worthlessness and suicidal ideation, had a low ability for discriminating the severity of depression, two proposed items (not participating in medical care and social withdrawal) appeared to be good markers of moderately severe major depressive disorder among cancer patients. In addition, the items "fearfulness or depressed appearance in face or body posture" and "brooding, self-pity or pessimism" may be good markers for mild major depressive disorders, while the item "cannot be cheered up, doesn't smile, no response to good news or funny situations" may be a good marker for severe major depressive disorder.
The findings of the present study suggest that alternative criteria may have utility in diagnosing depression severity in cancer patients.
本研究的目的是探讨几种诊断标准项目在判断癌症患者重度抑郁症严重程度方面的表现。
运用现代项目反应理论，我们在一系列728例已采用包容性方法诊断为重度抑郁症的癌症患者中，检验了《精神疾病诊断与统计手册》第四版（DSM-IV）所概述的诊断标准以及两套概念性诊断标准（恩迪科特标准和卡瓦诺标准）的表现。
虽然所有DSM-IV诊断标准，包括无价值感和自杀观念，区分抑郁症严重程度的能力较低，但两项提出的项目（不参与医疗护理和社交退缩）似乎是癌症患者中度重度重度抑郁症的良好指标。此外，“面部或身体姿势表现出恐惧或抑郁神情”和“沉思、自怜或悲观”这些项目可能是轻度重度抑郁症的良好指标，而“无法振作起来、不微笑、对好消息或有趣情境无反应”这一项目可能是重度重度抑郁症的良好指标。
本研究结果表明，替代标准在诊断癌症患者抑郁症严重程度方面可能具有实用价值。
