Binagwaho Agnes, Fawzi Mary C Smith, Agbonyitor Mawuena, Nsanzimana Sabin, Karema Corine, Remera Eric, Mutabazi Vincent, Shyirambere Cyprien, Cyamatare Patrick, Nutt Cameron, Wagner Claire, Condo Jeanine, Misago Nancy, Kayiteshonga Yvonne
Ministry of Health of Rwanda, P.O. Box 84, Kigali, Rwanda.
Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
BMC Pediatr. 2016 Feb 22;16:29. doi: 10.1186/s12887-016-0565-2.
Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term.
A validation study was conducted, comparing the Children's Depression Inventory (CDI) with a structured clinical assessment as the gold standard among children living with HIV ages 7-14 years in Rwanda. The response rate was 87 % and the analysis was performed among 100 study participants.
Twenty-five percent of children had a diagnosis of depression based on the clinical interview. Sensitivity of the CDI ranged from 44 to 76 % and specificity was 92 to 100 % for cut-off scores from 5 to 9. The area under the curve (AUC) for receiver operating characteristic analysis, an estimate of overall accuracy, was 0.87 (95 % confidence interval: 0.77 - 0.97).
The significant prevalence of depression among children living with HIV in Rwanda reflects a critical need to advance mental health care in this population. Although overall accuracy of the CDI is reasonable in this context, further research needs to be done to develop a more sensitive measure of depression in this vulnerable population. Development of a highly sensitive screening measure will be a fundamental step towards improving access to mental health care among children living with HIV, potentially improving health outcomes and quality of life in the long-term as this vulnerable population transitions into adulthood.
抑郁症常与慢性病共存，与艾滋病毒共存时会加速病情发展并缩短生存期。对于感染艾滋病毒的儿童，需要一种简短且准确的抑郁症筛查工具，以增加获得心理健康护理的机会，并从长远改善与艾滋病毒相关的结果。
开展了一项验证研究，在卢旺达对7至14岁感染艾滋病毒的儿童中，将儿童抑郁量表（CDI）与结构化临床评估（作为金标准）进行比较。应答率为87%，对100名研究参与者进行了分析。
根据临床访谈，25%的儿童被诊断为患有抑郁症。CDI的敏感性在44%至76%之间，截断分数为5至9时特异性为92%至100%。用于评估总体准确性的受试者工作特征分析曲线下面积（AUC）为0.87（95%置信区间：0.77 - 0.97）。
卢旺达感染艾滋病毒儿童中抑郁症的高患病率反映出该人群迫切需要改善心理健康护理。尽管在此背景下CDI的总体准确性合理，但仍需进一步研究，以开发一种针对这一弱势群体更敏感的抑郁症测量方法。开发一种高度敏感的筛查方法将是改善感染艾滋病毒儿童获得心理健康护理机会的关键一步，随着这一弱势群体步入成年期，有望从长远改善健康结果和生活质量。
