Leopold K A, Ahles T A, Walch S, Amdur R J, Mott L A, Wiegand-Packard L, Oxman T E
Section of Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Int J Radiat Oncol Biol Phys. 1998 Dec 1;42(5):1105-12. doi: 10.1016/s0360-3016(98)00346-0.
To validate a short, structured interview procedure that allows practicing oncologists to quickly and reliably identify mood disorders in their patients, and to estimate the prevalence and types of mood disorders in a radiation therapy patient setting, noting relationships between mood disorders and patient characteristics.
Consecutive, eligible adult patients from the practices of two radiation oncologists were administered the Primary Care Evaluation of Mental Disorders (PRIME-MD) by the treating physician. A subset of these patients was also evaluated with the SCID, administered by trained mental health care personnel. Agreement between the two instruments was examined using the kappa statistic. Prevalence of mood disorders was determined from the PRIME-MD. The significance of relationships between patient characteristics and mood disorders was examined by chi-square and ANOVA analysis, and subsequently by multivariate logistic regression analysis.
One hundred twenty-two patients were studied. Fifty-three of these were administered the SCID. Agreement between the two instruments was very good (kappa = 0.70). A diagnosis of a depressive or anxiety disorder by the PRIME-MD was made in 59 of the 122 patients (48%, 95% confidence interval = 39%, 58%). Multivariate analysis showed that a diagnosis of a depressive mood disorder was significantly related to pain intensity and prior history of depression.
We have demonstrated the validity and feasibility of the PRIME-MD administered by oncologists in making diagnoses of mood disorders. The prevalence of mood disorders in our set of patients undergoing a course of RT was nearly 50%. Future studies should describe the natural history of these disorders, and determine optimal intervention strategies.
验证一种简短的结构化访谈程序，该程序能让肿瘤专科医生快速且可靠地识别患者的情绪障碍，并估计放射治疗患者中情绪障碍的患病率及类型，同时记录情绪障碍与患者特征之间的关系。
来自两位放射肿瘤学家诊所的连续符合条件的成年患者由主治医生进行《初级精神障碍评估量表（PRIME - MD）》测评。这些患者中的一部分还由训练有素的精神卫生保健人员进行《精神障碍诊断与统计手册》（SCID）评估。使用kappa统计量检验两种工具之间的一致性。根据PRIME - MD确定情绪障碍的患病率。通过卡方检验和方差分析，随后进行多因素逻辑回归分析，检验患者特征与情绪障碍之间关系的显著性。
共研究了122名患者。其中53名患者接受了SCID测评。两种工具之间的一致性非常好（kappa = 0.70）。在122名患者中，有59名（48%，95%置信区间 = 39%，58%）被PRIME - MD诊断为患有抑郁或焦虑障碍。多因素分析表明，抑郁情绪障碍的诊断与疼痛强度和既往抑郁史显著相关。
我们已经证明了肿瘤学家使用PRIME - MD进行情绪障碍诊断的有效性和可行性。在我们这组接受放疗疗程的患者中，情绪障碍的患病率接近50%。未来的研究应描述这些障碍的自然病程，并确定最佳干预策略。
