CASE-FINDING INSTRUMENTS FOR DEPRESSION IN PRIMARY-CARE SETTINGS
CASE-FINDING INSTRUMENTS FOR DEPRESSION IN PRIMARY-CARE SETTINGS
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DOI：
10.7326/0003-4819-122-12-199506150-00004
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发表时间：
1995-06-15
影响因子：
39.2
通讯作者：
KERBER, C
中科院分区：
文献类型：
--
作者：
MULROW, CD;WILLIAMS, JW;KERBER, C
目的：评估病例发现工具在初级保健机构中识别重度抑郁症患者的有用性。数据来源：MEDLINE 英语医学文献检索；所选论文的参考书目；研究选择：选择了在初级保健机构中对未经选择的患者进行的研究，以及将病例发现工具与公认的重度抑郁症诊断标准进行比较的研究。数据综合：在 18 项研究中评估了 9 种病例发现工具。超过15000名患者接受了病例发现仪筛查；其中约 5300 人接受了标准评估。案例查找工具的长度从 2 到 28 个问题不等。平均给药时间从不到 2 分钟到 6 分钟不等。检测重度抑郁症的敏感性和特异性分别为 67% 至 99% 和 40% 至 95%。仪器之间没有发现显着差异。总体敏感性为 84%（95% CI，79% 至 89%）；总体特异性为 72%（CI，67% 至 77%）。如果对 100 名重度抑郁症患病率为 5% 的初级保健患者使用病例发现工具，临床医生预计将有 31 名患者筛查呈阳性，31 名患者中有 4 名患有重度抑郁症，而 1 名重度抑郁症患者不会被识别出来。结论：有几种具有合理操作特性的工具可帮助初级保健临床医生识别重度抑郁症患者。由于这些仪器的操作特性相似，因此特定仪器的选择应取决于可行性、管理和评分时间等问题，以及仪器服务于其他目的的能力，例如监测严重程度或对治疗的反应。
Objective: To evaluate the usefulness of case-finding instruments for identifying patients with major depression in primary care settings.Data Sources: A MEDLINE search of the English-language medical literature; bibliographies of selected papers; and experts.Study Selection: Studies that were done in primary care settings with unselected patients and that compared case-finding instruments with accepted diagnostic criterion standards for major depression were selected.Data Synthesis: 9 case-finding instruments were assessed in 18 studies. More than 15000 patients received screening with a case-finding instrument; approximately 5300 of these received criterion standard assessment. Case-finding instruments ranged in length from 2 to 28 questions. Average administration times ranged from less than 2 minutes to 6 minutes. Sensitivities and specificities for detecting major depression ranged from 67% to 99% and from 40% to 95%, respectively. No significant differences between instruments were found. Overall sensitivity was 84% (95% CI, 79% to 89%); overall specificity was 72% (CI, 67% to 77%). If a case-finding instrument were administered to 100 primary care patients with a 5% prevalence of major depression, the clinician could expect that 31 patients would screen positive, that 4 of the 31 would have major depression, and that 1 patient with major depression would not be identified.Conclusions: Several instruments with reasonable operating characteristics are available to help primary care clinicians identify patients with major depression. Because the operating characteristics of these instruments are similar, selection of a particular instrument should depend on issues such as feasibility, administration and scoring times, and the instruments' ability to serve additional purposes, such as monitoring severity or response to therapy.