Güleç Hüseyin, Karabekİroğlu Aytül, Yenel Aynil, Baykaran Mustafa Burak, Keleş Ünal Elif
İstanbul Erenköy Psychiatric and Neurological Disorders Training and Research Hospital, İstanbul, Turkey.
Samsun Mehmet Aydın Training and Research Hospital, Samsun, Turkey.
Noro Psikiyatr Ars. 2014 Sep;51(3):233-241. doi: 10.4274/npa.y6834. Epub 2014 Sep 1.
The aim of this study was to combine the dimensional concept with the categorical system in major depressive disorder (MDD) to reduce the complexity of the diagnosis. Furthermore, it was aimed to match categorical and dimensional approaches in a clear and simple manner.
The study included a patient group of 131 consecutive outpatients diagnosed with MDD according to the DSM-IV diagnosis criteria, and a control group of 99 people that is matched with the patient group by gender, age and education level. All subjects completed the Beck Depression Inventory, the Beck Anxiety Inventory and the Toronto Alexithymia Scale (TAS).
Cronbach's alpha values for the analysis of the internal consistency of the scale for the patients group, control group and the total participants were determined as .94-.97, .87-.92 and .93-.96, respectively. Nine factors were obtained from the results of exploratory factor analysis. According to the Scree-plot, it was decided that the two-factor structure represents best. Although depression and anxiety are two distinct dimensions, the relationship between them was found to be significantly significant. This was valid for both patient and control groups. When the relationship between the DSM-IV diagnosis criteria and all variables (depression and its sub-dimensions, anxiety and its sub-dimensions and the number of symptoms) was evaluated, the number of symptoms was found to be significantly related with all of the criteria.
The number of symptoms and the severity of illness are found to be important in the clinical manifestation of MDD. The relationship of the severity of the illness with sleep and appetite seems weaker. While loss of interest was mainly predicting the disorder, weight changes, psychomotor changes, difficulty in concentration, fatigue, and worthlessness were determined not to be predictors of the manifestations. According to dimensional approach, somatic anxiety and deterioration in performance predict the presence of the disorder. According to categorical and dimensional approaches, some of the DSM-IV criteria (#2, #1, #9, #4, number of symptoms, severity of symptoms, somatic anxiety, performance deterioration) are seen to contribute to the matchability between the approaches.
本研究的目的是将维度概念与重度抑郁症（MDD）的分类系统相结合，以降低诊断的复杂性。此外，旨在以清晰简单的方式使分类法和维度法相匹配。
该研究纳入了一组131名连续门诊患者，他们根据《精神疾病诊断与统计手册》第四版（DSM-IV）诊断标准被诊断为MDD，以及一组99人的对照组，该对照组在性别、年龄和教育水平上与患者组相匹配。所有受试者均完成了贝克抑郁量表、贝克焦虑量表和多伦多述情障碍量表（TAS）。
患者组、对照组和所有参与者量表内部一致性分析的克朗巴哈系数值分别确定为0.94 - 0.97、0.87 - 0.92和0.93 - 0.96。探索性因素分析结果得出九个因素。根据碎石图，确定两因素结构最能代表。尽管抑郁和焦虑是两个不同的维度，但发现它们之间的关系非常显著。这在患者组和对照组中均成立。当评估DSM-IV诊断标准与所有变量（抑郁及其子维度、焦虑及其子维度和症状数量）之间的关系时，发现症状数量与所有标准均显著相关。
发现症状数量和疾病严重程度在MDD的临床表现中很重要。疾病严重程度与睡眠和食欲的关系似乎较弱。虽然兴趣丧失主要预测该障碍，但体重变化、精神运动变化、注意力难以集中、疲劳和无价值感被确定不是临床表现的预测因素。根据维度法，躯体焦虑和表现恶化预测该障碍的存在。根据分类法和维度法，一些DSM-IV标准（#2、#1、#9、#4、症状数量、症状严重程度、躯体焦虑、表现恶化）有助于两种方法之间的匹配性。
