Zich J M, Attkisson C C, Greenfield T K
University of California, San Francisco.
Int J Psychiatry Med. 1990;20(3):259-77. doi: 10.2190/LYKR-7VHP-YJEM-MKM2.
The present study was undertaken to examine the utility of the Center for Epidemiological Studies-Depression (CES-D) scale and the Beck Depression Inventory (BDI) as screening instruments for primary care clinic patients. We examined: 1) patients' willingness to complete the scales; 2) the level of agreement between the screening instruments and DSM-III diagnosis of Major Depressive Episode, based on the NIMH Diagnostic Interview Schedule (DIS); 3) the effect on detection rates of raising the cut-off score for each depression screen; and 4) the factor structure of the CES-D in our primary care sample versus findings from general population studies. The CES-D and BDI performed comparably as depression screening instruments. Both produced too many false positives when standard (low) cut-off scores were applied. However, when straight cut-off scores were used, results suggested that either the CES-D or BDI might assist physicians in reliably detecting depressed patients, without an overload of false positives. Comparison of our findings with those from other studies suggest that depression screening instruments may be particularly helpful with older primary care patients. The CES-D factor analysis highlights the need to look more closely at the relevance of positive affect to the detection, diagnosis, and treatment of depressive disorders in primary care practices.
本研究旨在检验流行病学研究中心抑郁量表（CES-D）和贝克抑郁量表（BDI）作为基层医疗诊所患者筛查工具的效用。我们考察了：1）患者完成量表的意愿；2）基于美国国立精神卫生研究所诊断访谈表（DIS），筛查工具与重度抑郁发作的DSM-III诊断之间的一致程度；3）提高每个抑郁筛查的临界值对检出率的影响；4）在我们的基层医疗样本中CES-D的因子结构与一般人群研究结果的对比。CES-D和BDI作为抑郁筛查工具表现相当。当应用标准（低）临界值时，两者都会产生过多的假阳性。然而，当使用直接临界值时，结果表明CES-D或BDI可能有助于医生可靠地检测出抑郁患者，而不会产生过多的假阳性。将我们的研究结果与其他研究结果进行比较表明，抑郁筛查工具可能对老年基层医疗患者特别有帮助。CES-D因子分析突出表明，需要更密切地关注积极情绪在基层医疗实践中对抑郁症检测、诊断和治疗的相关性。
