Instituto de Salud Carlos III, Centro Investigación Biomédica en Red, CIBER, C/ Diego de León 62, 28006 Madrid, Spain.
Department of Medical Informatics, Biometry and Epidemiology (IBE), Research Unit for Biopsychosocial Health, Ludwig-Maximilians University (LMU), Marchioninistr. 15, 81377 Munich, Germany.
J Affect Disord. 2015 Dec 1;188:89-96. doi: 10.1016/j.jad.2015.08.035. Epub 2015 Sep 2.
Functional difficulties are determined as one of the reasons for the public health priority given to depression. However, previous literature shows that the evidence on treatment effectiveness in depression does not reflect all relevant functional areas affected. This paper aimed to review recent literature and identify which areas are addressed and what are the gaps in the measurement of treatment effectiveness in depression.
Electronic search was performed in PsycINFO, PubMed, Web of science, and the Cochrane Central Register of Controlled Trials. A content item analysis of outcome measures was performed.
Two hundred and fourty-seven studies were included. The functional areas addressed in the measurement process did not vary across studies assessing psychotherapeutic, pharmacological or alternative interventions. The content analysis revealed that 80% of the areas covered by instruments represented symptomatology. Many functional areas were insufficiently covered, whereas others like handling stress, solving problems, maintaining daily routine, problems in education, or participation in community, political or religious life were not addressed at all.
Only articles in English were included and the time frame was limited.
More than 10 years after the first global burden of disease studies have been published evidence on the treatment effectiveness in depression is still based primarily on symptoms. Many important functional areas remain unexplored. Consequently the effectiveness of well recognized interventions might be overestimated. Future steps should include use of comprehensive tools, provision of detailed information on functional areas instead of global scores of instruments, and design of functional impairment oriented therapies.
功能障碍被确定为导致抑郁症成为公共卫生重点关注问题的原因之一。然而，先前的文献表明，抑郁症治疗效果的证据并未反映所有受影响的相关功能领域。本文旨在回顾最新文献，确定哪些领域得到了关注，以及在抑郁症治疗效果的测量方面存在哪些差距。
在 PsycINFO、PubMed、Web of science 和 Cochrane 对照试验中心注册处进行电子检索。对结果测量的内容项目进行了分析。
共纳入 247 项研究。评估心理治疗、药物治疗或替代干预措施的研究中，测量过程中涉及的功能领域没有差异。内容分析显示，仪器涵盖的 80%的领域代表了症状。许多功能领域没有得到充分覆盖，而其他领域，如应对压力、解决问题、维持日常生活、教育问题或参与社区、政治或宗教生活等，根本没有涉及。
仅纳入了英文文章，且时间范围有限。
在首次全球疾病负担研究发表 10 多年后，抑郁症治疗效果的证据仍然主要基于症状。许多重要的功能领域仍未得到探索。因此，公认的干预措施的有效性可能被高估。未来的步骤应包括使用综合工具、提供关于功能领域的详细信息而不是仪器的综合评分，并设计以功能障碍为导向的治疗方法。
