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J Clin Psychiatry. 2014 Feb;75(2):141-6. doi: 10.4088/JCP.13m08458.
We recently found marked disparities between 3 self-report scales that assess the DSM-IV criteria for major depressive disorder in the percentage of depressed outpatients considered to have severe depression. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to calibrate the measures against a clinician-rated criterion standard and to establish a cutoff point on each scale that identifies a similar prevalence of severe depression and increases the level of agreement between the scales in identifying severe depression.
353 depressed outpatients (DSM-IV) completed the Clinically Useful Depression Outcome Scale, Quick Inventory of Depressive Symptomatology, and Patient Health Questionnaire from June 2010 to January 2013. The patients were also rated on the 17-item Hamilton Depression Rating Scale (HDRS). The goal of the analyses was to identify the cutoff point on each of the self-report scales that would identify a prevalence of severe depression similar to that identified by the HDRS (defined as a score of 25 and above).
On the basis of the scale developers' recommended cutoffs, the prevalence of severe depression varied greatly (range, 15.3%-67.4%), and the level of agreement between the pairs of scales was low. After calibration, the self-report scales identified a similar percentage of patients as severely depressed (range, 22.2%-26.5%), and the level of agreement between the scales in identifying severe depression increased.
If clinicians are to follow treatment guidelines' recommendations to base initial treatment selection, in part, on depression severity, then it is important to have a consistent method of determining depression severity. The present calibration study of 3 self-report depression questionnaires identified cutoff scores that resulted in similar prevalence rates of severe depression and increased the level of agreement between the scales.
我们最近发现，在被认为患有重度抑郁症的门诊抑郁症患者比例方面，用于评估 DSM-IV 重性抑郁障碍标准的 3 种自评量表之间存在显著差异。本研究来自罗德岛改善诊断评估和服务（MIDAS）项目，旨在根据临床医生评定的标准对这些量表进行校准，并为每个量表确定一个切点，该切点可识别出类似的重度抑郁患病率，并提高这些量表在识别重度抑郁方面的一致性水平。
2010 年 6 月至 2013 年 1 月期间，353 名符合 DSM-IV 的抑郁门诊患者完成了临床有用的抑郁结局量表、贝克抑郁自评量表和患者健康问卷。患者还接受了 17 项汉密尔顿抑郁评定量表（HDRS）的评定。分析的目的是确定每个自评量表的切点，该切点可识别出与 HDRS 相同的重度抑郁患病率（定义为得分 25 分及以上）。
根据量表开发者推荐的切点，重度抑郁的患病率差异很大（范围为 15.3%-67.4%），且量表之间的一致性水平较低。经过校准后，自评量表识别出相似比例的患者为重度抑郁（范围为 22.2%-26.5%），且量表在识别重度抑郁方面的一致性水平提高。
如果临床医生要根据治疗指南的建议，部分依据抑郁严重程度来选择初始治疗，那么确定抑郁严重程度的方法就显得非常重要。本研究对 3 种自评抑郁问卷进行了校准，确定了切点，这些切点可使重度抑郁的患病率相似，并提高了量表之间的一致性水平。
