Knäuper B, Wittchen H U
Max Planck Institute for Psychiatry, Clinical Institute, Munich, Germany.
J Psychiatr Res. 1994 Mar-Apr;28(2):147-64. doi: 10.1016/0022-3956(94)90026-4.
Recent epidemiological and family genetic studies in different countries using standardized diagnostic interviews for mental disorders have rather consistently demonstrated considerably lower current (e.g. ECA Study: 0.9%) and lifetime (1.4%) prevalence estimates of Major Depression in the elderly (older than 65 years of age) as compared to younger age groups (e.g. 30-44 years: 1 year, 3.9%; lifetime, 7.5%). Some investigators have questioned the validity of these data and suggested alternative interpretations. One possibility is that the complex standardized symptoms and clinical probe questions, and the required judgmental process inherent in diagnostic interviews exceed the cognitive capacity of older adults. This may result in systematic response bias. This paper examines the degree to which the lower prevalence estimates of depression in the elderly are biased due to specific characteristics of the assessment strategy. Analyses of epidemiologic data from the Munich Follow-up Study (MFS), based on the Diagnostic Interview Schedule, demonstrate that (1) older respondents report lifetime depressive symptoms with the same frequency as younger respondents. The additional probe questions designed to identify the degree to which symptoms were caused by factors other than psychological revealed that (2) the elderly more often attribute such symptoms to physical illnesses or conditions. This results in (3) the exclusion of the reported symptoms as a basis for diagnosing depression. A laboratory study demonstrated that "working memory capacity" was a good predictor of this response behavior, indicating that the complexity of the formalized questions exceeds the cognitive capacity of the elderly. Attributing symptoms to a physical illness or condition might be a heuristic strategy to simplify complex recall and judgment processes; the resulting answer is plausible but incorrect. We recommend that the symptom and probe questions of standardized diagnostic interviews be simplified, especially for use with the elderly.
近期，不同国家开展的流行病学和家庭遗传学研究采用标准化的精神障碍诊断访谈，结果相当一致地表明，与年轻年龄组（如30 - 44岁：1年患病率为3.9%；终生患病率为7.5%）相比，老年人（65岁以上）目前（如ECA研究：0.9%）和终生（1.4%）的重度抑郁症患病率估计值要低得多。一些研究人员对这些数据的有效性提出质疑，并给出了其他解释。一种可能性是，复杂的标准化症状和临床探查问题，以及诊断访谈中固有的判断过程超出了老年人的认知能力。这可能导致系统性的反应偏差。本文探讨了由于评估策略的特定特征，老年人抑郁症患病率估计值较低的程度受到了多大程度的偏差影响。基于诊断访谈表对慕尼黑随访研究（MFS）的流行病学数据进行分析表明：（1）老年受访者报告终生抑郁症状的频率与年轻受访者相同。旨在确定症状由心理因素以外的因素引起的程度的额外探查问题表明：（2）老年人更常将此类症状归因于身体疾病或状况。这导致（3）所报告的症状被排除在抑郁症诊断依据之外。一项实验室研究表明，“工作记忆能力”是这种反应行为的良好预测指标，这表明形式化问题的复杂性超出了老年人的认知能力。将症状归因于身体疾病或状况可能是一种简化复杂回忆和判断过程的启发式策略；得出的答案看似合理但不正确。我们建议简化标准化诊断访谈的症状和探查问题，尤其是用于老年人时。
