Zimmerman M, Lish J D, Farber N J, Hartung J, Lush D, Kuzma M A, Plescia G
Department of Psychiatry, Medical College of Pennsylvania.
Gen Hosp Psychiatry. 1994 Nov;16(6):388-96. doi: 10.1016/0163-8343(94)90114-7.
There is growing consensus that depression is a major public health problem causing significant psychosocial morbidity and mortality which should be addressed by case-finding effects in primary care settings. A large amount of literature has examined the ability of self-report questionnaires to detect depression in medical patients and the results have been encouraging. However, studies of general population and psychiatric patient samples indicate that depression is frequently comorbid with other psychiatric disorders, and that psychiatric disorders other than depression are also associated with significant morbidity and mortality. Consequently, we believe that psychiatric screening in primary care should be broad based. We administered a newly developed, multidimensional questionnaire (the SCREENER), that simultaneously screens for a range of DSM-III-R psychiatric disorders, to 508 medical outpatients attending a VA general medical clinic. Compared with nondepressed cases, the depressed patients significantly more often reported all of the nondepressive symptoms. Nine of the ten nondepressive disorders screened for by the SCREENER were significantly more frequent in the depressed group. Most patients who screened positive for depression also screened positive for at least one nondepressive disorder. Compared with patients who only screened positive for depression, those who screened positive for both depression and a nondepressive disorder rated their physical and emotional health more poorly and made more visits to the doctor. Compared with patients who did not screen positive for any disorder, those who only screened positive for a nondepressive disorder rated their physical and emotional health more poorly, and more frequently had a history of mental health treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
越来越多的人达成共识，即抑郁症是一个重大的公共卫生问题，会导致严重的心理社会发病率和死亡率，初级保健机构应通过病例发现措施来解决这一问题。大量文献研究了自我报告问卷在检测内科患者抑郁症方面的能力，结果令人鼓舞。然而，对普通人群和精神科患者样本的研究表明，抑郁症常与其他精神障碍共病，而且除抑郁症外的其他精神障碍也与显著的发病率和死亡率相关。因此，我们认为初级保健中的精神科筛查应具有广泛的基础。我们对508名前往退伍军人事务部综合内科诊所就诊的门诊患者进行了一项新开发的多维问卷（筛查问卷）的测试，该问卷可同时筛查一系列《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中的精神障碍。与非抑郁症患者相比，抑郁症患者报告所有非抑郁症状的频率明显更高。筛查问卷所筛查的十种非抑郁性障碍中有九种在抑郁症组中更为常见。大多数抑郁症筛查呈阳性的患者至少有一种非抑郁性障碍筛查也呈阳性。与仅抑郁症筛查呈阳性的患者相比，抑郁症和非抑郁性障碍筛查均呈阳性的患者对自己身体和情绪健康的评价更差，看医生的次数也更多。与任何障碍筛查均未呈阳性的患者相比，仅非抑郁性障碍筛查呈阳性的患者对自己身体和情绪健康的评价更差，且更常有心理健康治疗史。（摘要截选于250字）
