Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento UFRGS, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, Brazil.
J Affect Disord. 2021 Sep 1;292:583-591. doi: 10.1016/j.jad.2021.05.102. Epub 2021 Jun 5.
Major depressive disorder (MDD) is heterogeneous, but official diagnostic classifications and widely used rating scales are based on the premise that MDD is a single disorder and that symptoms are equally important to assess severity. Also, patients and clinicians frequently diverge in how they evaluate MDD severity. In order to better understand the differences between MDD scales used by clinicians and patients in the context of MDD heterogeneity, we performed a network analysis from an approach that focuses on the interaction of symptoms rather than total score.
The Hamilton Depression Rating Scale (HDRS) and the Beck Depression Inventory with 21 items (BDI) scored by the clinician or patient, respectively, were used to estimate the networks based on 794 MDD patients. The networks were estimated using software R 4.0.2 and Graphical Lasso, identifying communities of symptoms by the clique percolation method, and the mixed graphical models were used to evaluate the explained variance of each symptom.
The networks presented different communities of symptoms and connection structure (M = 0.177, p = 0.0028). The guilt connection strength and its association with suicidal ideation was greater in the BDI network.
Transversal data from severe, chronic, or treatment resistant depression patients.
The present study suggests that the self-rated scale may perform better when assessing association between guilt and other symptoms, especially suicidal ideation. Communities of symptoms and edges between symptoms suggest that insomnia may be an independent symptom, thus requiring specific interventions. Some similar items are strongly connected and could be collapsed.
重度抑郁症（MDD）是异质的，但官方的诊断分类和广泛使用的评定量表基于这样一个前提，即 MDD 是一种单一的障碍，症状同等重要以评估严重程度。此外，患者和临床医生在评估 MDD 严重程度方面经常存在分歧。为了更好地理解 MDD 异质性背景下临床医生和患者使用的 MDD 量表之间的差异，我们从关注症状相互作用而非总分的角度进行了网络分析。
分别由临床医生和患者对汉密尔顿抑郁评定量表（HDRS）和贝克抑郁量表第 21 项（BDI）进行评分，以 794 名 MDD 患者的数据来估计网络。使用 R 4.0.2 和图形拉索软件估计网络，通过团块渗滤方法识别症状群，使用混合图形模型评估每个症状的解释方差。
网络呈现出不同的症状群和连接结构（M=0.177，p=0.0028）。BDI 网络中的内疚连接强度及其与自杀意念的关联更大。
来自严重、慢性或治疗抵抗性抑郁症患者的横断数据。
本研究表明，在评估内疚与其他症状，特别是自杀意念之间的关联时，自我评估量表可能表现更好。症状群和症状之间的边缘表明，失眠可能是一个独立的症状，因此需要特定的干预措施。一些相似的项目连接紧密，可以合并。
