Foley D L, Neale M C, Kendler K S
Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298-0710, USA.
Psychol Med. 1998 Jul;28(4):857-70. doi: 10.1017/s0033291798006977.
In unselected samples, the diagnosis of major depression (MD) is not highly reliable. It is not known if occasion-specific influences on reliability index familial risk factors for MD, or how reliability is associated with risk for co-morbid anxiety disorders.
An unselected sample of 847 female twin pairs was interviewed twice, 5 years apart, about their lifetime history (LTH) of MD, generalized anxiety disorder (GAD) and panic disorder (PD). Familial influences on reliability were examined using structural equation models. Logistic regression was used to identify clinical features that predict reliable diagnosis. Co-morbidity was characterized using the continuation ratio test.
The reliability of a LTH of MD over 5 years was fair (kappa = 0.43). There was no evidence for occasion-specific familial influences on reliability, and heritability of reliably diagnosed MD was estimated at 66%. Subjects with unreliably diagnosed MD reported fewer symptoms and, if diagnosed with MD only at the first interview, less impairment and help seeking, or, if diagnosed with MD only at the second interview, fewer episodes and a longer illness. A history of co-morbid GAD or PD is more prevalent among subjects with reliably diagnosed MD.
A diagnosis of MD based on a single psychiatric interview incorporates a substantial amount of measurement error but there is no evidence that transient influences on recall and diagnosis index familial risk for MD. Quantitative indices of risk for MD based on multiple interviews should reflect both the characteristics of MD and the temporal order of positive diagnoses.
在未经过筛选的样本中，重度抑郁症（MD）的诊断并非高度可靠。目前尚不清楚特定场合对MD可靠性指标家族风险因素的影响，也不清楚可靠性与共病焦虑症风险之间的关联。
对847对女性双胞胎进行了未经过筛选的样本研究，相隔5年进行了两次访谈，询问她们MD、广泛性焦虑症（GAD）和惊恐障碍（PD）的终生病史（LTH）。使用结构方程模型检验家族对可靠性的影响。采用逻辑回归来确定预测可靠诊断的临床特征。使用连续比例检验来描述共病情况。
MD终生病史在5年内的可靠性一般（kappa = 0.43）。没有证据表明特定场合的家族因素会影响可靠性，可靠诊断的MD的遗传度估计为66%。MD诊断不可靠的受试者报告的症状较少，如果仅在第一次访谈中被诊断为MD，则损害和求助行为较少，或者，如果仅在第二次访谈中被诊断为MD，则发作次数较少且病程较长。在MD诊断可靠的受试者中，共病GAD或PD的病史更为普遍。
基于单次精神科访谈的MD诊断存在大量测量误差，但没有证据表明对回忆和诊断的短暂影响会影响MD的家族风险。基于多次访谈的MD风险定量指标应反映MD的特征以及阳性诊断的时间顺序。
