Results of the DSM-IV mood disorders field trial.
Results of the DSM-IV mood disorders field trial.
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DOI：
10.1176/ajp.152.6.843
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发表时间：
1995-06
期刊：
影响因子：
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通讯作者：
M. Keller;D. Klein;R. Hirschfeld;J. Kocsis;J. P. Mccullough;I. Miller;M. First;Charles P. Holzer;G. Keitner;D. Marin;T. Shea
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文献类型：
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作者：
M. Keller;D. Klein;R. Hirschfeld;J. Kocsis;J. P. Mccullough;I. Miller;M. First;Charles P. Holzer;G. Keitner;D. Marin;T. Shea
目的：DSM-IV心境障碍现场试验是一项多站点合作研究，旨在探索基于病程的重度抑郁症诊断分类系统的可靠性，评估心境障碍的症状标准，并探索对轻度心境障碍（如轻度和复发性短暂抑郁症）的额外诊断类别的需求。方法从5个地点的住院、门诊和社区环境中招募524名抑郁症受试者，根据DSM-III和DSM-III- r标准进行结构化访谈，并仔细关注纵向病程。还对样本子集进行了内部和跨站点的互测信度研究和6个月的重测信度研究。结果重度抑郁和心境恶劣的评价，站点内信度为好~优，站点间信度为一般~好；6个月的重测信度对心境恶劣者尚可，对重度抑郁症者差至尚可。六种疾病病程说明的互译者信度尚可，几乎所有受试者都可以被分配到特定类型的病程。结论：研究结果支持基于病程的重度抑郁症分类系统的应用。他们还建议，DSM-III-R恶劣心境症状标准的内容效度可以通过强调认知和社会/动机症状来提高，尽管这样的改变不太可能强化恶劣心境和重度抑郁症之间的区别。最后，91%的受试者符合当前或终生重度抑郁症或心境恶劣的标准，这表明不需要对轻度抑郁症进行额外的分类。
OBJECTIVE The DSM-IV mood disorders field trial, a multisite collaborative study, was designed to explore the reliability of a course-based diagnostic classification system for major depression, evaluate the symptom criteria for dysthymia, and explore the need for additional diagnostic categories for milder forms of mood disorder (e.g., minor and recurrent brief depression). METHOD Five hundred twenty-four depressed subjects were recruited from inpatient, outpatient, and community settings at five sites and evaluated with structured interviews according to DSM-III and DSM-III-R criteria, with careful attention to longitudinal course. Within- and across-site interrater reliability studies and 6-month test-retest reliability studies were also conducted on subsets of the sample. RESULTS For evaluations of major depression and dysthymia, intrasite reliability was good to excellent and intersite reliability was fair to good; 6-month test-retest reliability was fair for dysthymia and poor to fair for major depression. Interrater reliability for six course of illness specifiers was fair to good, and almost all subjects could be assigned to a specific type of course. CONCLUSIONS The results supported the use of a course-based classification system for major depression. They also suggested that the content validity of the DSM-III-R symptom criteria for dysthymia could be improved by emphasizing cognitive and social/motivational symptoms, although such changes are unlikely to sharpen the distinction between dysthymia and major depression. Finally, 91% of the subjects met the criteria for current or lifetime major depression or dysthymia, suggesting that additional categories for milder forms of depression are not needed.