Burrows A B, Satlin A, Salzman C, Nobel K, Lipsitz L A
Hebrew Rehabilitation Center for Aged, Boston, MA 02131, USA.
J Am Geriatr Soc. 1995 Oct;43(10):1118-22. doi: 10.1111/j.1532-5415.1995.tb07011.x.
Nurses commonly observe more depression than is diagnosed and treated in nursing homes. Accordingly, we aimed to describe the clinical features of untreated nursing home residents whom nurses identify as depressed and to compare nurse ratings of depressed nursing home residents with ratings from direct interviews and patient self-reports.
Cross-sectional survey followed by semi-structured diagnostic interviews of depressed patients and their nurses.
A large academic, multi-level, long-term care facility.
Thirty-seven patients aged 74-99 (mean age 88.4) whom nurses identified as having daily symptoms of depression. Subjects had Mini-Mental State Exam (MMSE) scores > 10 (mean score 21.2), were not acutely or terminally ill, and were able to participate in an interview.
DSM-III-R mood diagnoses and separate ratings of interviews with nurses and patients using the Cornell Scale for Depression.
Nurses observed daily symptoms of depression in 110 of 495 (22%) long-term care residents on units not reserved for advanced dementia. Of these 110 patients, 58 (53%) were not receiving antidepressants. Of 37 patients eligible for interviews, nine met criteria for major depression, 20 met criteria for another non-major depression diagnosis, and eight did not have a diagnosable mood disorder. Cornell scale ratings derived exclusively from interviews of nurses were similar across the three diagnostic groups (12.5, 9.9, and 9.5, respectively; P = .31; mean 10.5), whereas Cornell scale ratings from patient interviews differed among groups (15.9, 6.9, and 4.1, respectively; P < .001; mean 8.4). Correlation between nurse Cornell ratings and patient Cornell ratings was poor (r = .27), especially for patients with non-major forms of depression (r = -.20). MMSE and Cumulative Illness Rating Scale (CIRS-G) scores were similar in the three groups.
Nurses frequently observed symptoms of depression in a long-term care setting, and many symptomatic patients were not being treated with antidepressants. In these patients, nurse-derived symptom ratings did not vary across DSM-III-R diagnostic categories and correlated poorly with ratings from direct patient interviews. These findings suggest that nurse caregivers may contribute important diagnostic information about non-major depression and raise questions about the application of standard diagnostic categories to late-life depression in the nursing home.
护士在养老院观察到的抑郁症患者通常比已确诊并接受治疗的患者更多。因此，我们旨在描述护士认定为抑郁但未接受治疗的养老院居民的临床特征，并比较护士对抑郁养老院居民的评分与直接访谈及患者自我报告的评分。
横断面调查，随后对抑郁患者及其护士进行半结构化诊断访谈。
一家大型学术性、多层次的长期护理机构。
37名年龄在74 - 99岁（平均年龄88.4岁）的患者，护士认定他们有每日抑郁症状。受试者的简易精神状态检查表（MMSE）得分>10（平均得分21.2），非急性或晚期疾病患者，且能够参与访谈。
采用《精神疾病诊断与统计手册》第三版修订版（DSM - III - R）的情绪诊断标准，并用康奈尔抑郁量表分别对护士和患者的访谈进行评分。
在未预留给晚期痴呆患者的病房中，495名长期护理居民中有110名（22%）被护士观察到有每日抑郁症状。在这110名患者中，58名（53%）未接受抗抑郁药物治疗。在37名符合访谈条件的患者中，9名符合重度抑郁症标准，20名符合其他非重度抑郁症诊断标准，8名没有可诊断的情绪障碍。仅基于护士访谈得出的康奈尔量表评分在三个诊断组中相似（分别为12.5、9.9和9.5；P = 0.31；平均10.5），而患者访谈的康奈尔量表评分在各组间存在差异（分别为15.9、6.9和4.1；P < 0.001；平均8.4）。护士的康奈尔评分与患者的康奈尔评分之间的相关性较差（r = 0.27），尤其是对于非重度抑郁形式的患者（r = -0.20）。三组患者的MMSE和累积疾病评定量表（CIRS - G）得分相似。
护士在长期护理环境中经常观察到抑郁症状，许多有症状的患者未接受抗抑郁药物治疗。在这些患者中，护士得出的症状评分在DSM - III - R诊断类别中没有差异，且与患者直接访谈的评分相关性较差。这些发现表明，护士护理人员可能提供有关非重度抑郁症的重要诊断信息，并引发了关于将标准诊断类别应用于养老院老年抑郁症的问题。
