Reifler B V, Okimoto J T, Heidrich F E, Inui T S
J Fam Pract. 1979 Oct;9(4):623-8.
Physicians diagnosed depression in 4.5 percent (59/1,321) of all patient encounters in this study conducted in a university based family medicine residency program. A subset of residents permitted the investigators to interview those patients who were diagnosed as depressed or who were judged to be at high risk for a missed diagnosis of depression. Of the six patients whom the residents diagnosed as depressed and who agreed to be interviewed, two did not meet the criteria for depression but in neither case was this discrepancy judged clinically significant. Of the 24 patients at high risk for a missed diagnosis who agreed to be interviewed, four met the diagnostic criteria and three of these four missed diagnoses were judged as possibly of clinical significance. While the physicians in this study diagnosed depression more frequently than in previous similar studies, this does not appear to represent over-diagnosis, although the small number of patients interviewed requires that interpretations be made cautiously. The authors suggest that if a primary care physician diagnoses depression in less than 2 percent of patient encounters, he or she should consider the possibility of missed diagnoses.
在这项以大学为基础的家庭医学住院医师培训项目中开展的研究里，医生在所有患者诊疗中诊断出抑郁症的比例为4.5%（59/1321）。一部分住院医师允许研究人员对那些被诊断为抑郁症或被判定有漏诊抑郁症高风险的患者进行访谈。在住院医师诊断为抑郁症且同意接受访谈的6名患者中，有2名不符合抑郁症标准，但在这两种情况下，这种差异在临床上均不被认为具有显著意义。在同意接受访谈的24名有漏诊高风险的患者中，有4名符合诊断标准，这4例漏诊中有3例被判定可能具有临床意义。虽然本研究中的医生诊断抑郁症的频率高于以往类似研究，但这似乎并不代表过度诊断，尽管接受访谈的患者数量较少，需要谨慎解读。作者建议，如果初级保健医生在不到2%的患者诊疗中诊断出抑郁症，他或她应考虑漏诊的可能性。
