Christensen Kaj Sparle, Oernboel Eva, Nielsen Marie Germund, Bech Per
a Research Unit for General Practice and Section for General Medical Practice, Department of Public Health , Aarhus University , Aarhus , Denmark.
b Research Clinic for Functional Disorders and Psychosomatics , Aarhus University Hospital , Aarhus , Denmark.
Scand J Prim Health Care. 2019 Mar;37(1):105-112. doi: 10.1080/02813432.2019.1568703. Epub 2019 Jan 28.
This study aims to assess the measurement properties of the Major Depression Inventory (MDI) in a clinical sample of primary care patients.
General practitioners (GPs) handed out the MDI to patients aged 18-65 years on clinical suspicion of depression.
Thirty-seven general practices in the Central Denmark Region participated in the study.
Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1-3) and after dichotomization of items according to diagnostic procedure.
Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Key points The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice. This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure. Minor problems with measurement structure should be addressed in future revisions of the MDI.
本研究旨在评估在基层医疗患者临床样本中，重度抑郁量表（MDI）的测量特性。
全科医生（GPs）在临床怀疑患者患有抑郁症时，将MDI发放给年龄在18 - 65岁的患者。
丹麦中部地区的37家全科诊所参与了该研究。
分析纳入了363名咨询全科医生的患者数据（65%为女性，平均年龄：49.8岁，标准差：17.7）。
测试量表对拉施模型的整体拟合度、单个项目和个体的拟合度以及反应类别是否充分。进行了局部依赖性、单维度性、项目功能差异以及量表正确靶向性的统计检验。计算了个体分离信度指数。所有分析均使用RUMM2030软件进行。
第9项和第10项表现出与拉施模型不拟合，所有项目均表现出反应类别无序。将原始的六点计分系统修改为五点计分系统后，所有10个项目都实现了有序的反应类别。MDI项目似乎很好地针对了所研究的人群。抑郁的核心症状（第1 - 3项）以及根据诊断程序对项目进行二分法处理后，也实现了模型拟合。
尽管MDI的测量结构存在一些小问题，但它似乎是在基层医疗中识别成年人抑郁症的有效工具。研究结果支持基于核心症状进行抑郁症筛查，并根据诊断程序对项目进行二分法处理。要点 重度抑郁量表（MDI）在全科医疗中广泛用于抑郁症的筛查、诊断和监测。本研究表明第9项和第10项与拉施模型不拟合，需要修改计分系统。研究结果支持基于核心症状进行抑郁症筛查，并根据诊断程序对项目进行二分法处理。MDI测量结构中的小问题应在未来修订中加以解决。
