Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
BMC Psychiatry. 2012 Nov 1;12:187. doi: 10.1186/1471-244X-12-187.
Given the high prevalence of depression in primary health care (PHC), the use of screening instruments has been recommended. Both brief and long depression screening instruments have been validated in low and middle income countries (LMIC), including within HIV care settings. However, it remains unknown whether the brief instruments validated in LMIC are as accurate as the long ones.
We conducted a search of PUBMED, the COCHRANE library, AIDSLINE, and PSYCH-Info from their inception up to July 2011, for studies that validated depression screening instruments in LMIC. Data were extracted into tables and analyzed using RevMan 5.0 and STATA 11.2 for the presence of heterogeneity.
Nineteen studies met our inclusion criteria. The reported prevalence of depression in LMIC ranged from 11.1 to 53%. The area under curve (AUC) scores of the validated instruments ranged from 0.69-0.99. Brief as well as long screening instruments showed acceptable accuracy (AUC≥0.7). Five of the 19 instruments were validated within HIV settings. There was statistically significant heterogeneity between the studies, and hence a meta-analysis could not be conducted to completion. Heterogeneity chi-squared = 189.23 (d.f. = 18) p<.001.
Brief depression screening instruments in both general and HIV-PHC are as accurate as the long ones. Brief scales may have an edge over the longer instruments since they can be administered in a much shorter time. However, because the ultra brief scales do not include the whole spectrum of depression symptoms including suicide, their use should be followed by a detailed diagnostic interview.
鉴于初级卫生保健（PHC）中抑郁的高患病率，建议使用筛选工具。简短和长程抑郁筛选工具已在中低收入国家（LMIC）得到验证，包括在艾滋病毒护理环境中。然而，尚不清楚在 LMIC 中验证的简短工具是否与长程工具一样准确。
我们在 PUBMED、COCHRANE 图书馆、AIDSLINE 和 PSYCH-INFO 中进行了检索，从它们的创建开始到 2011 年 7 月，以寻找在 LMIC 中验证抑郁筛选工具的研究。将数据提取到表格中，并使用 RevMan 5.0 和 STATA 11.2 进行分析，以确定是否存在异质性。
有 19 项研究符合我们的纳入标准。报告的 LMIC 中抑郁的患病率为 11.1%至 53%。验证工具的曲线下面积（AUC）评分范围为 0.69-0.99。简短和长程筛选工具都显示出可接受的准确性（AUC≥0.7）。19 个工具中有 5 个在艾滋病毒环境中得到验证。研究之间存在统计学显著的异质性，因此无法完成荟萃分析。异质性 chi-squared = 189.23（df = 18）p<0.001。
普通和 HIV-PHC 中的简短抑郁筛选工具与长程工具一样准确。简短的量表可能比长的量表更有优势，因为它们可以在更短的时间内进行管理。然而，由于超简短量表不包括包括自杀在内的所有抑郁症状的全貌，因此应在使用后进行详细的诊断访谈。
