Lyness J M, Noel T K, Cox C, King D A, Conwell Y, Caine E D
Department of Psychiatry, University of Rochester School of Medicine and Dentistry, NY, USA.
Arch Intern Med. 1997 Feb 24;157(4):449-54.
Later-life depressive disorders are a major public health problem in primary care settings. A validated screening instrument might aid in the recognition of depression. However, available findings from younger patients may not generalize to older persons, and existing studies of screening instruments in older patient samples have suffered substantial methodological limitations.
One hundred thirty patients 60 years or older attending 3 primary care internists' practices participated in the study. Two screening scales were used: the Center for Epidemiologic Studies-Depression Scale (CES-D) and the Geriatric Depression Scale (GDS). The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised, was used to establish "gold standard" diagnoses including major and minor depressive disorders. Receiver operating curve analysis was used to determine each scale's operating characteristics.
Both the CES-D and the GDS had excellent properties in screening for major depression. The optimum cutoff point for the CES-D was 21, yielding a sensitivity of 92% and a specificity of 87%. The optimum cutoff point for the GDS was 10, yielding a sensitivity of 100% and a specificity of 84%. A shorter version of the GDS had a sensitivity of 92% and a specificity of 81% using a cutoff point of 5. All scales lost accuracy when used to detect minor depression or the presence of any depressive diagnosis.
The CES-D and the GDS have excellent properties for use as screening instruments for major depression in older primary care patients. Because the GDS's yes or no format may ease administration, primary care clinicians should consider its routine use in their practices.
晚年抑郁症是基层医疗环境中的一个主要公共卫生问题。一种经过验证的筛查工具可能有助于识别抑郁症。然而，来自年轻患者的现有研究结果可能不适用于老年人，并且在老年患者样本中对筛查工具的现有研究存在重大方法学局限性。
130名60岁及以上在3名基层医疗内科医生处就诊的患者参与了该研究。使用了两种筛查量表：流行病学研究中心抑郁量表（CES-D）和老年抑郁量表（GDS）。采用《精神障碍诊断与统计手册》第三版修订本的结构化临床访谈来确定包括重度和轻度抑郁症在内的“金标准”诊断。采用受试者工作特征曲线分析来确定每个量表的操作特征。
CES-D和GDS在筛查重度抑郁症方面均具有优异性能。CES-D的最佳截断点为21，灵敏度为92%，特异度为87%。GDS的最佳截断点为10，灵敏度为100%，特异度为84%。GDS的一个较短版本在截断点为5时灵敏度为92%，特异度为81%。当用于检测轻度抑郁症或任何抑郁诊断的存在时，所有量表的准确性均下降。
CES-D和GDS作为老年基层医疗患者重度抑郁症的筛查工具具有优异性能。由于GDS的是或否格式可能便于实施，基层医疗临床医生应考虑在其实践中常规使用。
