Williams J W, Kerber C A, Mulrow C D, Medina A, Aguilar C
Division of General Internal Medicine, Audie L. Murphy Memorial Veterans Affairs Hospital, San Antonio, TX 78284, USA.
J Gen Intern Med. 1995 Jan;10(1):7-12. doi: 10.1007/BF02599568.
To assess the relative prevalence of subsyndromal depression (SubD) and major depression (MDD) in primary care patients and describe their associated functional impairments, and to define the operating characteristics of a short depression screen (SDS).
Three primary care clinics: a university-affiliated Veterans Affairs clinic, a county general internal medicine clinic, and a community health center.
Randomly selected adult patients (n = 221), aged > or = 30 years, with no history of psychiatric comorbidity, current substance abuse, major depressive disorder, chronic pain disorder, or dementia.
The SDS and the Medical Outcomes Study Short Form 36 (SF-36) were interviewer-administered by an experienced bilingual research assistant to all subjects in the language of their choice. A physician administered independently the Structured Clinical Interview for DSM-III diagnosis (SCID) and the Hamilton Depression Rating Scale (HDRS) to all patients who exceeded a minimum threshold on the SDS and to a randomly selected sample of patients who had subthreshold scores. MDD was defined by DSM-III criteria and SubD was defined as two to four DSM-III criteria, of which one had to be depressed mood or anhedonia.
Demographic and clinical characteristics of the patients were: Mexican American 53%, non-Hispanic white 38%, and African American 9%; men 68%; mean age 60 +/- 12.7 years; mean level of education 9.5 +/- 4.4 years; and hypertension 57%, diabetes mellitus 51%, and arthritis 45%. The prevalences of MDD and SubD (adjusted for sampling strategy) were 4% and 16%, respectively. For the patients who had MDD, the median HDRS score was 17 (interquartile range, 10-18), and for those who had SubD, the median HDRS score was 9 (interquartile range, 8-14). Compared with the patients who did not have depressive symptoms, those who had either MDD or SubD were significantly impaired in multiple domains of self-reported function. The sensitivity and specificity of the SDS for MDD were 100% (95% CI 57-100) and 72% (95% CI 63-81), respectively. For depressive disorders (MDD or SubD), the sensitivity was 66% (95% CI 49-83) and the specificity was 79% (95% CI 69-89).
SubD was more prevalent than MDD in these primary care settings. Both MDD and SubD were associated with significant functional impairment. The sensitivity of the SDS was lower for identifying depressive disorders (MDD or SubD) than it was for identifying MD.
评估基层医疗患者中亚综合征性抑郁（SubD）和重度抑郁（MDD）的相对患病率，描述其相关的功能损害，并确定一种简短抑郁筛查量表（SDS）的操作特征。
三家基层医疗诊所：一家大学附属退伍军人事务诊所、一家县综合内科诊所和一家社区健康中心。
随机选取年龄≥30岁、无精神疾病共病史、无当前药物滥用、无重度抑郁症、无慢性疼痛障碍或痴呆症的成年患者（n = 221）。
由一名经验丰富的双语研究助理以受试者选择的语言对所有受试者进行SDS和医学结局研究简表36（SF - 36）的访谈式评估。医生独立对所有SDS得分超过最低阈值的患者以及随机选取的SDS得分低于阈值的患者样本进行DSM - III诊断的结构化临床访谈（SCID）和汉密尔顿抑郁评定量表（HDRS）评估。MDD根据DSM - III标准定义，SubD定义为符合两到四条DSM - III标准，其中一条必须是情绪低落或快感缺失。
患者的人口统计学和临床特征为：墨西哥裔美国人占53%，非西班牙裔白人占38%，非裔美国人占9%；男性占68%；平均年龄60±12.7岁；平均受教育程度9.5±4.4年；高血压患者占57%，糖尿病患者占51%，关节炎患者占45%。MDD和SubD的患病率（经抽样策略调整后）分别为4%和16%。患有MDD的患者，HDRS得分中位数为17（四分位间距，10 - 18），患有SubD的患者，HDRS得分中位数为9（四分位间距，8 - 14）。与没有抑郁症状的患者相比，患有MDD或SubD 的患者在自我报告功能的多个领域存在显著损害。SDS对MDD的敏感性和特异性分别为100%（95%CI 57 - 100）和72%（95%CI 63 - 81）。对于抑郁障碍（MDD或SubD），敏感性为66%（95%CI 49 - 83），特异性为79%（95%CI 69 - 89）。
在这些基层医疗环境中，SubD比MDD更普遍。MDD和SubD均与显著的功能损害相关。SDS识别抑郁障碍（MDD或SubD）的敏感性低于识别MDD的敏感性。
