Nielsen Marie Germund, Ørnbøl Eva, Bech Per, Vestergaard Mogens, Christensen Kaj Sparle
Research Unit for General Practice, Department of Public Health, Aarhus University.
Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus.
Clin Epidemiol. 2017 Jul 6;9:355-365. doi: 10.2147/CLEP.S132913. eCollection 2017.
The Major Depression Inventory (MDI) is widely used in Danish general practice as a screening tool to assess depression in symptomatic patients. Nevertheless, no validation studies of the MDI have been performed. The aim of this study was to validate the web-based version of the MDI against a fully structured telephone interview in a population selected on clinical suspicion of depression (ie, presence of two or three core symptoms of depression) in general practice.
General practitioners (GPs) invited consecutive persons suspected of depression to complete the web-based MDI in a primary care setting. The validation was based on the Munich-Composite International Diagnostic Interview (M-CIDI) by phone. GPs in the 22 practices in our study included 132 persons suspected of depression. Depression was rated as yes/no according to the MDI and M-CIDI. Sensitivity, specificity, and positive predictive value of the International Classification of Diseases, Tenth Revision (ICD-10) algorithms of the MDI were examined.
According to the M-CIDI interview, 87.9% of the included population was depressed and 64.4% was severely depressed. According to the MDI scale, 59.1% of the population was depressed and 31.8% was severely depressed. The sensitivity of the MDI for depression was 62.1% (95% confidence interval [95% CI]: 52.6-70.9) and the specificity was 62.5% (95% CI: 35.4-84.8). The sensitivity for severe depression was 42.2% (95% CI: 30.6-52.4) and the specificity was 85.1% (95% CI: 71.7-93.8). The receiver operating curve showed an area under the curve of 0.66 (95% CI: 0.52-0.81) for any depression and of 0.72 (95% CI: 0.63-0.81) for severe depression.
The MDI is a conservative instrument for diagnosing ICD-10 depression in a clinical setting compared to the M-CIDI interview. Only a few false-positive diagnoses were identified when the MDI was used on clinical suspicion of depression.
在丹麦的全科医疗中，重度抑郁量表（MDI）被广泛用作评估有症状患者抑郁状况的筛查工具。然而，尚未对MDI进行过验证研究。本研究的目的是在全科医疗中对因临床怀疑患有抑郁症（即存在两种或三种抑郁核心症状）而入选的人群，将基于网络的MDI版本与完全结构化的电话访谈进行对照验证。
全科医生（GP）邀请连续就诊的疑似抑郁症患者在初级保健机构中完成基于网络的MDI。验证基于慕尼黑综合国际诊断访谈（M-CIDI）电话访谈。我们研究中22家诊所的全科医生纳入了132名疑似抑郁症患者。根据MDI和M-CIDI将抑郁评定为是/否。对MDI的国际疾病分类第十版（ICD-10）算法的敏感性、特异性和阳性预测值进行了检查。
根据M-CIDI访谈，纳入人群中87.9%患有抑郁症，64.4%患有重度抑郁症。根据MDI量表，该人群中59.1%患有抑郁症，31.8%患有重度抑郁症。MDI对抑郁症的敏感性为62.1%（95%置信区间[95%CI]：52.6 - 70.9），特异性为62.5%（95%CI：35.4 - 84.8）。对重度抑郁症的敏感性为42.2%（95%CI：30.6 - 52.4），特异性为85.1%（95%CI：71.7 - 93.8）。受试者工作特征曲线显示，对于任何抑郁症，曲线下面积为0.66（95%CI：0.52 - 0.81）；对于重度抑郁症，曲线下面积为0.72（95%CI：0.63 - 0.81）。
与M-CIDI访谈相比，MDI在临床环境中是一种用于诊断ICD-10抑郁症的保守工具。当基于临床怀疑使用MDI诊断抑郁症时，仅发现少数假阳性诊断。
