Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Barcelona, Spain.
Gen Hosp Psychiatry. 2010 Mar-Apr;32(2):201-9. doi: 10.1016/j.genhosppsych.2009.11.015. Epub 2010 Jan 12.
The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria.
Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed.
GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP.
GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.
本研究旨在：(1) 探讨全科医生做出的抑郁诊断的有效性及其相关因素；(2) 评估抑郁治疗的充分性及其相关因素；(3) 研究当使用不同的评估方法和标准时，治疗充分性的比率如何变化。
在具有代表性的加泰罗尼亚的 77 个初级保健中心进行了一项流行病学调查。共评估了 3815 名患者。
根据 DSM-IV 轴 I 障碍的结构临床访谈 (SCID-I)，全科医生识别出 339 名被诊断为重度抑郁发作的患者中的 69 名（敏感性 0.22；kappa 值：0.16）。患者主要抱怨存在情绪问题与识别概率增加相关。根据标准，充分性的比率不同：在 SCID-I 访谈中检测到的病例中，仅使用患者自我报告的数据时，充分性为 39.35%，而同时考虑临床图表中的数据时，充分性为 54.91%。当评估全科医生认为抑郁的患者的充分性时，充分性的比率更高。
全科医生充分治疗了他们认为大多数抑郁的患者。然而，与精神病学的金标准相比，他们未能识别出抑郁患者。治疗充分性的比率根据评估方法的不同而有很大差异。
