Lustman P J, Clouse R E, Griffith L S, Carney R M, Freedland K E
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Psychosom Med. 1997 Jan-Feb;59(1):24-31. doi: 10.1097/00006842-199701000-00004.
The purpose of this study was to determine the utility of the Beck Depression Inventory (BDI) as a screening tool for major depression in diabetes.
One hundred seventy-two diabetic outpatients (insulin-dependent diabetes mellitus [IDDM] = 59, or non-insulin-dependent diabetes mellitus [NIDDM] = 113) being evaluated for a treatment trial were studied. BDI scores were calculated for the complete 21-item measure as well as for the cognitive (13 items) and somatic (eight items) symptom subgroups. The presence of depression was determined using the National Institute of Mental Health Diagnostic Interview Schedule in accordance with the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Receiver operating characteristic (ROC) analyses were used to evaluate the performance of the screening test in relation to the diagnostic standard.
Depressed subjects were effectively discriminated from nondepressed subjects by using the full 21-item BDI, the cognitive items alone, or the somatic items alone (p < .001 for each comparison), although the cognitive items were more effective than the somatic items (p < .0005). BDI total scores between 12 and 14 inclusive displayed the best balance between sensitivity (0.90-0.82) and specificity (0.84-0.89), but a cutoff score > or = 16 for the entire 21-item measure exhibited the best balance between sensitivity and positive predictive value when prediction values were extrapolated to a diabetic population with a depression prevalence rate of 20%. This cutoff score would capture > 70% of the patients diagnosed with major depression yet provide > 70% certainty that a person screening positive actually has the psychiatric disorder.
The BDI is an effective screening test for major depression in diabetic patients. Prospective studies are needed to confirm the test's precise performance characteristics in the general clinical setting.
本研究旨在确定贝克抑郁量表（BDI）作为糖尿病患者重度抑郁筛查工具的效用。
对172名接受治疗试验评估的糖尿病门诊患者（胰岛素依赖型糖尿病[IDDM]=59例，非胰岛素依赖型糖尿病[NIDDM]=113例）进行研究。计算完整的21项量表以及认知（13项）和躯体（8项）症状亚组的BDI得分。根据《精神障碍诊断与统计手册》（DSM-III-R）标准，使用美国国立精神卫生研究所诊断访谈表确定是否存在抑郁。采用受试者工作特征（ROC）分析来评估筛查试验相对于诊断标准的性能。
使用完整的21项BDI、单独的认知项目或单独的躯体项目均能有效区分抑郁患者和非抑郁患者（每次比较p<.001），尽管认知项目比躯体项目更有效（p<.0005）。BDI总分在12至14（含）之间时，敏感性（0.90 - 0.82）和特异性（0.84 - 0.89）之间表现出最佳平衡，但当将预测值外推到抑郁症患病率为20%的糖尿病患者群体时，整个21项量表的临界值≥16在敏感性和阳性预测值之间表现出最佳平衡。该临界值能识别出>70%被诊断为重度抑郁的患者，同时能提供>70%的确定性，即筛查呈阳性的人实际上患有精神疾病。
BDI是糖尿病患者重度抑郁的有效筛查试验。需要进行前瞻性研究以确认该试验在一般临床环境中的精确性能特征。
