Department of Family Medicine and Community Health, University of Minnesota, St. Paul, MN 55103, USA.
J Am Board Fam Med. 2011 Mar-Apr;24(2):187-93. doi: 10.3122/jabfm.2011.02.100197.
Diagnostic and Statistical Manual (DSM) IV-based depression interviews, valued for their diagnostic accuracy, are often considered to be essential for depression treatment trials. However, this requirement can be problematic because of participant burden. The purpose of this article is to describe our experience with the depression component of the Structured Clinical Interview for DSM Disorders (SCID) in a postpartum depression treatment trial.
In this prospective cohort study of 506 mothers of infants from 7 primary care clinics, participants were asked to complete the depression module of the SCID interview soon after enrollment. They were asked to complete the 9-item Patient Health Questionnaire (PHQ-9) depression survey at 0 to 1, 2, 4, 6, and 9 months postpartum.
Forty-five women (8.9%) had a positive SCID interview and 112 (22.1%) had a positive PHQ-9 during 0 to 9 months postpartum. Problems encountered when using the SCID depression interview included (1) lower than expected SCID-based rates of depression diagnosis (8.9%); (2) SCID noncompletion by 75 women (14.8%); SCID noncompleters (vs completers) were younger, poorer, less educated, and more likely to be single and black (vs white); and (3) inconsistent SCID/PHQ-9 results. Nineteen women with moderately severe to severe PHQ-9 score elevations (≥15) had negative SCID scores; all of these women were functionally impaired. More than 90% of women with positive PHQ-9 scores reported some degree of impairment because of their depressive symptoms.
The requirement of a diagnostic depression interview resulted in selection bias and missed opportunities for depression diagnosis; these are problems that detract from the interview's key strength-its diagnostic accuracy. These problems should be considered when electing to use a DSM-IV-based depression interview in research.
基于《精神疾病诊断与统计手册》（DSM-IV）的抑郁访谈因其诊断准确性而备受重视，通常被认为是抑郁症治疗试验所必需的。然而，由于参与者的负担，这一要求可能会带来问题。本文旨在描述我们在一项产后抑郁症治疗试验中使用《精神疾病诊断与统计手册》障碍定式临床检查（SCID）的抑郁部分的经验。
在这项来自 7 家初级保健诊所的 506 名婴儿母亲的前瞻性队列研究中，参与者在入组后不久被要求完成 SCID 访谈的抑郁模块。他们被要求在产后 0 至 1、2、4、6 和 9 个月时完成 9 项患者健康问卷（PHQ-9）抑郁调查。
45 名女性（8.9%）的 SCID 访谈呈阳性，112 名女性（22.1%）在产后 0 至 9 个月时的 PHQ-9 呈阳性。在使用 SCID 抑郁访谈时遇到的问题包括：（1）基于 SCID 的抑郁诊断率低于预期（8.9%）；（2）75 名女性（14.8%）未能完成 SCID；未完成 SCID 的女性（与完成者相比）更年轻、更贫穷、受教育程度更低，且更有可能单身和黑人（与白人相比）；（3）SCID 和 PHQ-9 的结果不一致。19 名 PHQ-9 评分中度至重度升高（≥15）的女性 SCID 评分呈阴性；所有这些女性的功能都受损。超过 90%的 PHQ-9 评分阳性的女性报告说，由于抑郁症状，她们的生活受到了某种程度的影响。
对诊断性抑郁访谈的要求导致了选择偏倚和诊断抑郁症的机会错失；这些问题削弱了访谈的关键优势——其诊断准确性。在选择使用基于 DSM-IV 的抑郁访谈进行研究时，应考虑这些问题。
