Department of Psychiatry, Seoul National University Hospital, Seoul 110-744, Republic of Korea.
J Affect Disord. 2013 Jun;148(2-3):235-42. doi: 10.1016/j.jad.2012.11.065. Epub 2012 Dec 25.
Many patients with mood disorders report subjective indicators of depression that are inconsistent with clinicians' objective ratings. This study used the self-report Beck Depressive Inventory (BDI) and the observer-rated Hamilton Depression Rating Scale (HAMD) to evaluate the extent to which temperament, personality traits, and clinical characteristics accounted for discrepancies between self-reports and clinician ratings of depressive symptoms in patients experiencing the euthymic period of a mood disorder.
The sample consisted of 100 individuals with bipolar disorder (n=72) or major depressive disorder (n=28). The HAMD and Young Mania Rating Scale were administered, and participants completed the BDI and Barratt Impulsivity Scale. Intelligence was assessed with the Korean Wechsler Adult Intelligence Scale. Patients completed the Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire and the NEO-Five-Factor Inventory.
The BDI and HAMD were significantly but modestly correlated with each other (r=0.319, p<0.001). Lower intelligence and a less conscientious personality were independent contributors to differences between Z-scores for the BDI and the HAMD. Higher impulsivity and a more anxious temperament were also observed in the group that self-reported more symptoms than were noted by clinicians.
Generalizability of results can be limited in ethnic difference.
Subjective and objective assessments of the depressive symptoms of patients with mood disorders in a euthymic mood state are frequently discordant. Clinicians should consider the subjective aspects of depressive symptoms along with objective information about the influence of intelligence and personality on patients' self-reports.
许多患有心境障碍的患者报告的抑郁主观指标与临床医生的客观评定不一致。本研究使用自评贝克抑郁量表(BDI)和观察者评定汉密尔顿抑郁评定量表(HAMD),评估气质、人格特质和临床特征在多大程度上解释了心境障碍患者处于心境稳定期时的抑郁症状的自我报告与临床医生评定之间的差异。
样本包括 100 名双相情感障碍(n=72)或单相重性抑郁障碍(n=28)患者。对患者进行 HAMD 和 Young 躁狂评定量表评定,同时患者完成 BDI 和巴瑞特冲动量表评定。使用韩国韦氏成人智力量表评估智力。患者完成孟菲斯、比萨、巴黎和圣地亚哥自动问卷的气质评估和 NEO-五因素量表。
BDI 和 HAMD 之间存在显著但适度的相关性(r=0.319,p<0.001)。较低的智力和较低的尽责人格是 BDI 和 HAMD 评分之间差异的独立影响因素。在自我报告的症状比临床医生观察到的症状更多的患者中,还观察到更高的冲动性和更焦虑的气质。
结果的推广性可能因种族差异而受到限制。
在心境稳定状态下,对心境障碍患者的抑郁症状进行主观和客观评估通常是不一致的。临床医生应考虑抑郁症状的主观方面,同时考虑智力和人格对患者自我报告的影响的客观信息。