Badger L W, deGruy F V, Hartman J, Plant M A, Leeper J, Anderson R, Ficken R, Gaskins S, Maxwell A, Rand E
School of Social Work, University of Alabama School of Medicine, Tuscaloosa 35487-0326.
Psychosom Med. 1994 Mar-Apr;56(2):128-35. doi: 10.1097/00006842-199403000-00008.
This study was undertaken in order to better understand the detection of depression by primary care physicians. Specifically, we investigated the relationship between information gathered during the course of the medical interview and the subsequent diagnosis of depression. Forty-seven community-based primary care physicians, unaware of the mental health focus of this research, were videotaped in the office setting, as they interviewed two "typical" standardized patients who met DSM-III-R criteria for major depression. One patient presented with headaches and the other presented with palpitations and chest pain. After each interview, physicians were provided with physical findings and results of any diagnostic procedures they ordered, then asked to construct and explicate their differential diagnoses. The two patients were correctly diagnosed as depressed by 53 and 45% of the physicians. Although detection was related to greater amounts of information gathered, inquiry about the DSM-III-R criteria symptoms was generally low, and in no case was sufficient information acquired to make a formal DSM-III-R diagnosis of depression. However, a subset of the DSM-III-R symptoms (those related to disturbances of appetite, sleep, and other neurovegetative functions) were among the reasons cited for inclusion of depression in the differential, as were psychosocial stressors and the patient's appearance. These findings suggest that detection of depression is low by primary care physicians.
开展这项研究是为了更好地了解初级保健医生对抑郁症的诊断情况。具体而言，我们调查了在医疗问诊过程中收集的信息与后续抑郁症诊断之间的关系。47名社区初级保健医生在办公室环境中对两名符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）重度抑郁症标准的“典型”标准化患者进行问诊时被录像，这些医生并不知道该研究关注心理健康。一名患者表现为头痛，另一名患者表现为心悸和胸痛。每次问诊后，向医生提供他们所做的体格检查结果以及所开任何诊断程序的结果，然后要求他们构建并阐述鉴别诊断。53%和45%的医生正确诊断出这两名患者患有抑郁症。虽然诊断与收集到的信息量增加有关，但对DSM-III-R标准症状的询问普遍较少，而且在任何情况下都没有获得足以做出正式的DSM-III-R抑郁症诊断的充分信息。然而，DSM-III-R症状的一个子集（那些与食欲、睡眠及其他植物神经功能紊乱有关的症状）是将抑郁症纳入鉴别诊断的原因之一，社会心理压力源和患者的外表也是如此。这些发现表明初级保健医生对抑郁症的诊断率较低。
