Robbins J M, Kirmayer L J, Cathébras P, Yaffe M J, Dworkind M
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
Med Care. 1994 Aug;32(8):795-812. doi: 10.1097/00005650-199408000-00004.
We examined physician characteristics associated with the recognition of depression and anxiety in primary care. Fifty-five physicians treating a total of 600 patients completed measures of psychosocial orientation, psychological mindedness, self-rating of sensitivity to hidden emotions, and a video test of sensitivity to nonverbal communication. Patients were classified as cases of psychiatric distress based on the CES-D scale and the Diagnostic Interview Schedule. Physician recognition was determined by notation of any psychosocial diagnosis in the medical charts over the ensuing 12 months. Of 192 patients scoring 16 or above on the CES-D, 44% (83) were recognized as psychiatrically distressed. Three findings were central to this study: 1) Physicians who are more sensitive to nonverbal expressions of emotion made more psychiatric or psychosocial assessment of their patients and appeared to be over-inclusive in their judgments of psychosocial problems; 2) Physicians who tended to blame depressed patients for causing, exaggerating, or prolonging their depression made fewer psychosocial assessments and were less accurate in detecting psychiatric distress; 3) False positive labeling of patients who had no evidence of psychiatric distress was rare. Surprisingly, more severe medical illness increased the likelihood of labeling and accurate recognition. Physician factors that increased recognition may indicate a greater willingness to formulate a psychiatric diagnosis and an ability notice nonverbal signs of distress.
我们研究了与初级保健中抑郁症和焦虑症识别相关的医生特征。55名医生共治疗了600名患者，他们完成了社会心理取向、心理敏锐性、对隐藏情绪敏感性的自评以及非语言沟通敏感性的视频测试。根据流调中心抑郁量表（CES-D）和诊断访谈表，患者被分类为精神困扰病例。医生的识别是通过在随后12个月的病历中记录任何社会心理诊断来确定的。在CES-D得分16分及以上的192名患者中，44%（83名）被识别为有精神困扰。本研究有三个核心发现：1）对情绪的非语言表达更敏感的医生对患者进行的精神或社会心理评估更多，并且在对社会心理问题的判断上似乎过于宽泛；2）倾向于指责抑郁症患者导致、夸大或延长其抑郁状态的医生进行的社会心理评估较少，在检测精神困扰方面也不太准确；3）对没有精神困扰证据的患者进行假阳性标记的情况很少见。令人惊讶的是，更严重的疾病增加了标记和准确识别的可能性。增加识别率的医生因素可能表明他们更愿意做出精神科诊断，并且有能力注意到困扰的非语言迹象。
