Angstman Kurt B, Garrison Gregory M, Gonzalez Cesar A, Cozine Daniel W, Cozine Elizabeth W, Katzelnick David J
From the Departments of Family Medicine (KBA, GMG, CAG), Information Technology (DWC), and Psychiatry and Psychology, Division of Integrated Behavioral Health (CAG, DJK), Mayo Clinic, Rochester, MN; and the Department of Family Medicine, Mayo Clinic, Zumbrota (EWC).
J Am Board Fam Med. 2017 May-Jun;30(3):281-287. doi: 10.3122/jabfm.2017.03.160313.
The goal of this study was to develop and validate an assessment tool for adult primary care patients diagnosed with depression to determine predictive probability of clinical outcomes at 6 months.
We retrospectively reviewed 3096 adult patients enrolled in collaborative care management (CCM) for depression. Patients enrolled on or before December 31, 2013, served as the training set (n = 2525), whereas those enrolled after that date served as the preliminary validation set (n = 571).
Six variables (2 demographic and 4 clinical) were statistically significant in determining clinical outcomes. Using the validation data set, the remission classifier produced the receiver operating characteristics (ROC) curve with a c-statistic or area under the curve (AUC) of 0.62 with predicted probabilities than ranged from 14.5% to 79.1%, with a median of 50.6%. The persistent depressive symptoms (PDS) classifier produced an ROC curve with a c-statistic or AUC of 0.67 and predicted probabilities that ranged from 5.5% to 73.1%, with a median of 23.5%.
We were able to identify readily available variables and then validated these in the prediction of depression remission and PDS at 6 months. The DOC-6 tool may be used to predict which patients may be at risk for worse outcomes.
本研究的目的是开发并验证一种针对被诊断为抑郁症的成年初级保健患者的评估工具，以确定6个月时临床结局的预测概率。
我们回顾性分析了3096名参与抑郁症协作护理管理（CCM）的成年患者。2013年12月31日或之前入组的患者作为训练集（n = 2525），而在该日期之后入组的患者作为初步验证集（n = 571）。
六个变量（2个人口统计学变量和4个临床变量）在确定临床结局方面具有统计学意义。使用验证数据集，缓解分类器生成的受试者工作特征（ROC）曲线的c统计量或曲线下面积（AUC）为0.62，预测概率范围为14.5%至79.1%，中位数为50.6%。持续性抑郁症状（PDS）分类器生成的ROC曲线的c统计量或AUC为0.67，预测概率范围为5.5%至73.1%，中位数为23.5%。
我们能够识别易于获得的变量，并在预测6个月时的抑郁症缓解和PDS方面对其进行验证。DOC-6工具可用于预测哪些患者可能有更差结局的风险。
