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首页> 外文期刊>The journal of clinical psychiatry >How can we use depression severity to guide treatment selection when measures of depression categorize patients differently?
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How can we use depression severity to guide treatment selection when measures of depression categorize patients differently?

机译：当抑郁症的测量方法对患者进行不同的分类时，我们如何使用抑郁症的严重程度来指导治疗选择？

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Objective: Treatment guidelines for depression suggest that severity should be taken into account when initiating treatment. If clinicians are to consider illness severity in selecting among treatment options for depression, then it is important to have reliable, valid, and clinically useful methods of distinguishing between levels of depression severity. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared 3 self-report scales that assess the DSM-IV criteria for major depressive disorder on the basis of how these scales distribute patients into severity categories. Method: From June 2010 to November 2011, 245 depressed outpatients completed the Clinically Useful Depression Outcome Scale (CUDOS), Quick Inventory of Depressive Symptomatology (QIDS), and Patient Health Questionnaire (PHQ-9). The study was conducted at Rhode Island Hospital, Providence, Rhode Island. The patients were subdivided into severity categories according to the cutoff scores recommended by each scales' developers. The patients were also rated on the 17-item Hamilton Depression Rating Scale (HDRS-17). Results: The correlations between the HDRS-17 and the 3 self-report scales were nearly identical. Yet the scales significantly differed in their distribution of patients into severity categories. On the CUDOS and HDRS-17, moderate depression was the most frequent severity category, whereas on the PHQ-9 and QIDS, the majority of the patients were classified as severe. Significantly fewer patients were classified as severely depressed on the CUDOS compared to the PHQ-9 (McNemar = 153.8; P < .001) and QIDS (McNemar = 114.0; P < .001). Conclusions: If clinicians are to follow treatment guidelines' recommendations to base initial treatment selection on the severity of depression, then it is important to have a consistent method of determining depression severity. The marked disparity between standardized scales in the classification of depressed outpatients into severity groups indicates that there is a problem with the use of such instruments to classify depression severity. Caution is warranted in the use of these scales to guide treatment selection until the thresholds to define severity ranges have been empirically established.
机译：目的：抑郁症的治疗指南建议在开始治疗时应考虑严重程度。如果临床医生在选择抑郁症的治疗方案时要考虑疾病的严重程度，那么重要的是要有可靠，有效且临床上有用的方法来区分抑郁症的严重程度。在罗德岛州改善诊断评估和服务方法（MIDAS）项目的本报告中，我们比较了3种自我报告量表，这些量表根据重度抑郁症如何将患者分为严重程度类别来评估DSM-IV标准。方法：从2010年6月至2011年11月，共有245名抑郁症患者完成了临床有用的抑郁结果量表（CUDOS），抑郁症状快速调查表（QIDS）和患者健康问卷（PHQ-9）。该研究在罗德岛普罗维登斯的罗德岛医院进行。根据每个量表开发人员推荐的临界值，将患者分为严重程度类别。还用17个项目的汉密尔顿抑郁量表（HDRS-17）对患者进行了评分。结果：HDRS-17与3个自我报告量表之间的相关性几乎相同。然而，在严重程度类别的患者分布上，量表存在显着差异。在CUDOS和HDRS-17上，中度抑郁是最常见的严重程度类别，而在PHQ-9和QIDS上，大多数患者被分类为严重。与PHQ-9（McNemar = 153.8; P <.001）和QIDS（McNemar = 114.0; P <.001）相比，被归类为CUDOS严重抑郁的患者要少得多。结论：如果临床医生要按照治疗指南的建议以抑郁症的严重程度作为初始治疗选择的基础，那么确定一致的抑郁症严重程度的方法就很重要。在将抑郁症门诊病人分为严重程度组时，标准化量表之间存在显着差异，表明使用此类工具对抑郁症严重程度进行分类存在问题。在使用这些量表来指导治疗选择时应谨慎行事，直到根据经验确定定义严重程度范围的阈值为止。

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