Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.
Research Unit for General Practice, Institute of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
BMC Fam Pract. 2021 May 7;22(1):88. doi: 10.1186/s12875-021-01432-w.
Methods to enhance the accuracy of the depression diagnosis continues to be of relevance to clinicians. The primary aim of this study was to compare the diagnostic precision of two different diagnostic strategies using the Mini International Neuropsychiatric Interview (MINI) as a reference standard. A secondary aim was to evaluate accordance between depression severity found via MINI and mean Major Depression Inventory (MDI) sum-scores presented at referral.
This study was a two-armed, cluster-randomized superiority trial embedded in the Collabri trials investigating collaborative care in Danish general practices. GPs performing case-finding were instructed always to use MDI when suspecting depression. GPs performing usual clinical assessment were instructed to detect depression as they would normally do. According to guidelines, GPs would use MDI if they had a clinical suspicion, and patients responded positively to two or three core symptoms of depression. We compared the positive predictive value (PPV) in the two groups.
Fifty-one GP clusters were randomized. In total, 244 participants were recruited in the case-finding group from a total of 19 GP clusters, and 256 participants were recruited in the usual clinical assessment group from a total of 19 GP clusters. The PPV of the GP diagnosis, when based on case-finding, was 0.83 (95% CI 0.78-0.88) and 0.93 (95% CI 0.89-0.96) when based on usual clinical assessment. The mean MDI sum-scores for each depression severity group indicated higher scores than suggested cut-offs.
In this trial, systematic use of MDI on clinical suspicion of depression did not improve the diagnostic precision compared with the usual clinical assessment of depression.
The trial was retrospectively registered on 07/02/2016 at ClinicalTrials.gov. No. NCT02678845 .
提高抑郁症诊断准确性的方法一直是临床医生关注的焦点。本研究的主要目的是比较两种不同诊断策略的诊断精度，以迷你国际神经精神访谈（MINI）作为参考标准。次要目的是评估通过 MINI 发现的抑郁严重程度与转诊时平均抑郁量表（MDI）总分之间的一致性。
这是一项在丹麦普通诊所开展的合作护理 Collabri 试验中嵌入的双臂、集群随机优势试验。进行病例发现的全科医生被指示在怀疑有抑郁症时始终使用 MDI。进行常规临床评估的全科医生被指示按照常规进行抑郁症检测。根据指南，如果全科医生有临床怀疑，并且患者对抑郁症的两个或三个核心症状有积极反应，他们会使用 MDI。我们比较了两组的阳性预测值（PPV）。
51 个全科医生集群被随机分组。共有 244 名参与者从 19 个全科医生集群中的病例发现组招募，共有 256 名参与者从 19 个全科医生集群中的常规临床评估组招募。基于病例发现的全科医生诊断的 PPV 为 0.83（95%CI 0.78-0.88），基于常规临床评估的为 0.93（95%CI 0.89-0.96）。每个抑郁严重程度组的平均 MDI 总分表明得分高于建议的截断值。
在这项试验中，在怀疑有抑郁症时系统地使用 MDI 并不能提高与常规抑郁症临床评估相比的诊断精度。
该试验于 2016 年 7 月 7 日在 ClinicalTrials.gov 上进行了回顾性注册。编号 NCT02678845。
