Parker G, Gladstone G, Wilhelm K, Hickie I, Mitchell P, Hadzi-Pavlovic D, Austin M P, Eyers K
Psychiatry Unit, Prince of Wales Hospital, Randwick, New South Wales, Australia.
Aust N Z J Psychiatry. 1998 Feb;32(1):104-11. doi: 10.3109/00048679809062716.
The aim of this paper is to describe an approach to sub-typing non-melancholic depression and to determine which raters from a variety of backgrounds provided the most valid information on study variables.
A sample of non-melancholic depressed patients is described. Multiple raters (i.e. patients, psychiatrists, referrers and corroborative witnesses) completed measures of the patient's trait anxiety levels, severity of recent life event stressors and personality functioning.
The study and representative data are reported. Congruence between several measures employed indicated that psychiatrist rating of disordered personality was superior to corroborative witness report. Assessment of anxiety traits indicated reasonable agreement between referrers and corroborative witnesses but poor agreement between those ratings and interview-elicited ratings. There were also discrepancies in quantifying 'severity' of life event stress, with patients and their corroborative witnesses rating such events as more severe than either the interviewing psychiatrist or psychiatrists involved in consensus rating sessions. Importantly, the psychiatrists' capacity to quantify the relative contribution of disordered personality, anxiety and life-event stress to the particular depressive episode was supported.
Results indicate some of the difficulties in operationalising determinants that may contribute to and sub-type the non-melancholic depressions, and demonstrate the advantages of using a range of rating strategies and raters. In this study, psychiatrist-generated judgements are clearly favoured, although the advantages of also assessing trait anxiety and life-event stress impact by self-report strategies are conceded. Some techniques for estimating the contribution of disordered personality function, anxiety and life-event stress are offered for both their research and their clinical utility.
本文旨在描述一种对非忧郁症抑郁症进行亚型分类的方法，并确定来自不同背景的评估者中，哪些能就研究变量提供最有效的信息。
描述了一组非忧郁症抑郁症患者样本。多个评估者（即患者、精神科医生、转诊者和确证证人）完成了对患者特质焦虑水平、近期生活事件应激源严重程度和人格功能的测量。
报告了该研究及代表性数据。所采用的几种测量方法之间的一致性表明，精神科医生对人格障碍的评分优于确证证人的报告。焦虑特质评估表明，转诊者和确证证人之间的意见较为一致，但这些评分与访谈得出的评分之间的一致性较差。在量化生活事件应激的“严重程度”方面也存在差异，患者及其确证证人对这些事件的评分比访谈精神科医生或参与共识评分会议的精神科医生给出的评分更高。重要的是，精神科医生对人格障碍、焦虑和生活事件应激对特定抑郁发作的相对贡献进行量化的能力得到了支持。
结果表明，在将可能导致非忧郁症抑郁症并对其进行亚型分类的决定因素进行操作化时存在一些困难，并证明了使用一系列评分策略和评估者的优势。在本研究中，虽然也承认通过自我报告策略评估特质焦虑和生活事件应激影响的优势，但精神科医生得出的判断显然更受青睐。提供了一些用于估计人格障碍功能、焦虑和生活事件应激贡献的技术，以说明其在研究和临床中的实用性。
