A comparison of self-report and clinical diagnostic interviews for depression -: Diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore Epidemiologic Catchment Area follow-up
A comparison of self-report and clinical diagnostic interviews for depression -: Diagnostic interview schedule and schedules for clinical assessment in neuropsychiatry in the Baltimore Epidemiologic Catchment Area follow-up
复制标题
DOI：
10.1001/archpsyc.57.3.217
复制
发表时间：
2000-03-01
影响因子：
--
通讯作者：
Cai, GJ
中科院分区：
文献类型：
--
作者：
Eaton, WW;Neufeld, K;Cai, GJ
背景资料：精神病流行病学领域继续采用自我报告工具，但使用这些工具与精神科医生在临床模式中获得的诊断之间的低程度一致性威胁到结果的可信度。方法：在巴尔的摩流行病学集水区随访中，349人进行了诊断访谈计划（DIS）的访谈，由精神科医生使用神经精神病学临床评估计划（SCAN）进行盲法检查。在诊断水平、证候水平和DSM-IV症状组水平进行比较。协议的指数进行计算和差异的情况下identified.Results的特点：协议的诊断重度抑郁症是唯一公平的（Kappa = 0.20），与DIS失踪的许多情况下判断为符合标准的诊断使用扫描（29%的敏感性）。差异的一个主要来源是具有假阴性诊断的受访者，他们一再未能报告归因于生活危机或医疗状况的DIS症状。使用逻辑回归分析，年龄较大、男性和低损伤与DIS检测不足相关。尽管诊断的差异，有大量的相关性的症状组的数量在2种方式（r = 0.49）。协议是最高的（约55%的灵敏度和90%的特异性）时，SCAN和DIS阈值被设置在抑郁症综合征的水平，而不是diagnosis.Conclusions：弱协议的诊断水平继续威胁到的可信度估计患病率的特定疾病。对低报的偏见，以及在抑郁综合征水平和抑郁症状的顺序测量上更强的一致性，表明与危险因素的关联是保守的。
Background: The field of psychiatric epidemiology continues to employ self-report instruments, but the low degree of agreement between diagnoses achieved using these instruments vs that achieved by psychiatrists in the clinical modality threatens the credibility of the results.Methods: In the Baltimore Epidemiologic Catchment Area follow-up, 349 individuals who had a Diagnostic Interview Schedule (DIS) interview were blindly examined by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Comparisons were made at the level of diagnosis, syndrome, and DSM-IV symptom group. Indexes of agreement were computed and characteristics of discrepant cases were identified.Results: Agreement on diagnosis of major depressive disorder was only fair (kappa = 0.20),with the DIS missing many cases judged to meet criteria for diagnosis using the SCAN (29% sensitivity). A major source of discrepancy was respondents with false-negative diagnoses who repeatedly failed to report DIS symptoms attributed to life crises or medical conditions. Older age, male sex, and lower impairment were associated with underdetection by the DIS, using logistic regression analysis. In spite of the diagnostic discrepancy, there was substantial correlation in numbers of symptom groups in the 2 modalities (r = 0.49). Agreement was highest (about 55% sensitivity and 90% specificity) when both the SCAN and DIS thresholds were set at the level of depression syndrome instead of diagnosis.Conclusions: Weak agreement at the level of diagnosis continues to threaten the credibility of estimates of prevalence of specific disorders. A bias toward underreporting, as well as stronger agreement at the level of the depression syndrome and on ordinal measures of depressive symptoms, suggests that associations with risk factors are conservative.