未辅助的全科医生对抑郁患者的临床诊断：一项初步研究。

Department of Family Medicine, Andrija Štampar School of Public Health, Rockfellerova 4, 10000 Zagreb, Croatia.

Psychiatr Danub. 2010 Dec;22(4):535-9.

BACKGROUND

In this study we wished to determine the diagnostic accuracy of unaided general practitioners' (GPs') clinical diagnosis in the evaluation of depression in depressed patients under their care compared with the Beck Depression Inventory II (BDI-II).

SUBJECTS AND METHODS

From 17,000 patients in 10 GPs' offices as representative sample in the city of Zagreb, 5100 patients from three GPs' offices were selected. The sample consisted of 53 out of 76 depressed patients with a diagnosis of Depressive episode (F32) or Recurrent depressive disorder (F33) classified according to ICD-10 and assessed by review of the GP's standardized medical records. Cross-sectional investigation was performed during February 2008. GPs classified depressed patients as either nondepressed without therapy, nondepressed with therapy or depressed with therapy. Within a two-week period, the unaided GPs' diagnosis was compared with BDI-II performed by psychologists unfamiliar with the GPs' assessment. Based on the GP vs. BDI-II comparison, patients were classified as either positive, false positive, false negative or negative. Sensitivity, specificity, PPV, and NPV associated with physician identification of depression were calculated by standard methods.

RESULTS

Depressiveness was found by BD-II in the group 'depressed with therapy' (24.39±10.91). ANOVA found a significant difference in BDI-II means between the outcome groups (P<0.001). Scheffe's procedure found a significant difference in BDI-II in patients with therapy (nondepressed vs. depressed) (P<0.001) and nondepressed without therapy vs. depressed with therapy (P<0.001). There were 16 depressed patients, 27 nondepressed, 2 false positive, and 8 false negative. Unaided GPs' clinical diagnosis showed 66% sensitivity, 93%, specificity, 88% PPV, and 77% NPV.

CONCLUSION

Unaided GPs' clinical diagnosis with 88% PPV outperforms other measures of patient depression and is easier to implement when compared to the psychiatric model of caseness, which is based on screening instruments.

背景

在这项研究中，我们希望确定未经培训的全科医生（GP）在评估其照顾下的抑郁患者时，仅凭临床诊断与贝克抑郁量表第二版（BDI-II）相比的诊断准确性。

方法

从 17000 名在萨格勒布市 10 家 GP 办公室的代表性样本中，选择了 3 家 GP 办公室的 5100 名患者。样本包括根据 ICD-10 分类的 76 名抑郁患者中的 53 名，患有抑郁发作（F32）或复发性抑郁障碍（F33），并通过审查 GP 的标准化病历进行评估。横断面调查于 2008 年 2 月进行。GP 将抑郁患者分为未经治疗的非抑郁患者、经治疗的非抑郁患者或经治疗的抑郁患者。在两周内，未经培训的 GP 诊断与心理学家进行的 BDI-II 进行比较，心理学家不了解 GP 的评估。基于 GP 与 BDI-II 的比较，患者被分为阳性、假阳性、假阴性或阴性。通过标准方法计算与医生识别抑郁相关的敏感性、特异性、PPV 和 NPV。

结果

BD-II 在“经治疗的抑郁患者”组中发现了抑郁（24.39±10.91）。方差分析发现，结局组之间的 BDI-II 均值存在显著差异（P<0.001）。Scheffe 程序发现，治疗组（非抑郁与抑郁）（P<0.001）和未经治疗的非抑郁与经治疗的抑郁患者（P<0.001）之间的 BDI-II 存在显著差异。有 16 名抑郁患者、27 名非抑郁患者、2 名假阳性患者和 8 名假阴性患者。未经培训的 GP 临床诊断的敏感性为 66%，特异性为 93%，PPV 为 88%，NPV 为 77%。