自杀相关研究中识别抑郁症状的不同方法比较

The identifiability for depressive symptoms of different methods in suicide prevention research

目的在自杀相关研究中对不同方法识别抑郁症状的情况进行比较。方法纳入自杀死亡案例(自杀组)151例和自杀未遂案例(未遂组)120例,每个案例的同吃住家属和其他亲友各1名及自杀未遂者本人接受访谈,均采用抑郁症诊断筛查量表(筛查表)和定式临床精神科检查(structured clinical interview for DSM-ⅣaxisⅠdisorders,SCID-Ⅰ)识别案例对象的抑郁症状,并以认可任一来源阳性信息为原则将每个案例的家属和其他亲友的报告合并成知情人信息。比较两种工具在相同信息来源情况下抑郁症状阳性率,以及各自在不同信息来源的情况下抑郁症状阳性率。结果自杀组中,知情人信息筛查表和SCID-Ⅰ符合"重性抑郁发作"的阳性率为41.1%(62例)和41.7%(63例),Kappa值0.77。未遂组中,本人受访时两工具的"重性抑郁发作"阳性率分别为23.7%(27例)和22.0%(24例),Kappa值0.74;而依据知情人信息,相应的阳性率分别为13.3%(16例)和12.5%(15例),Kappa值0.89。相对于家属和亲友单独提供信息,合并知情人信息后,两工具各症状阳性率以及符合症状学标准的比例均有所提高(均P<0.05)。未遂者本人受访时两工具检出"重性抑郁发作"的阳性率均高于知情人信息(均P<0.05)。结论相同信息来源下,SCID-Ⅰ对抑郁症状的识别能力不弱于筛查表;增加信息来源可提高识别抑郁症状的阳性率。自杀未遂者本人受访时抑郁症状的阳性率高于其知情人信息。

Objective To compare the identifiability for depressive symptoms using different instruments while interviewing with different respondents in suicide prevention research in China. Methods One hundred and fifty-one suicide death cases（suicide group） and one hundred and twenty suicide attempt cases（attempt group） were recruited.For each identified cases, one family member proxy respondent, and another associate proxy respondent（friend or neighbor） and suicide attempter（only for attempt group） were interviewed separately by qualified psychiatrists. The Di-agnostic Screening Instrument for Depression（DSID） and the Structured Clinical Interview for DSM-Ⅳ Axis I Disorders（SCID-Ⅰ） were administered to each respondent to identify the depressive symptoms based on diagnostic criteria for major depressive episode in DSM-Ⅳ. Data collected from family members and associate respondents were merged as proxy data. The concordances of the DSID and SCID-Ⅰ for identifying depressive symptoms, meeting for criteria of Major Depressive Episode（MDE） and Mild and Major Depressive Episode（MMDE）, were calculated based on different respondents’ data.The prevalence of depressive symptoms,MDE and MMDE,were compared among merged proxy data,family member respondent’s data,and associate respondent’s data in suicide group and attempt group,and between selfrespondent’s data and merged proxy data in suicide attempt group.Results In suicide group,based on merged proxy data,the prevalence of MDE was 41.1%（62 cases）for DSID and 41.7%（63 cases）for SCID-Ⅰ,and the Kappa coefficient was 0.77.Based on suicide attempters’self-raported data,the prevalence of MDE was 23.7%（27 cases）and22.0%（24 cases）for DSID and SCID-Ⅰrespectively,with a Kappa of 0.74.Based on merged proxy report in attempt group,16（13.3%）and 15（12.5%）cases were met for criteria of MDE（Kappa=0.89）,using the 2 instruments.In both of the suicide and attempt groups,the merged proxy data got higher prevalence of depressive symptoms,MDE and MMDE than that only based on family respondent’s data or associate’s respondent’s data using both of the 2 instruments（all P〈0.05）.Compared with merged proxy data,attempters’self-reported data got higher prevalence of MMD and MMDE using both of the 2 instruments（all P〈0.05）.Conclusions Based on same respondent’s data,SCID-Ⅰperforms as well as DSID in identifying depressive symptoms.Collecting data from 2 respondents would get higher prevalence of MDE or MMDE than only from one family member or one associate.In attempt group,the prevalence of MDE or MMDE based on merged proxy data were lower than that based on attempters’self-reported data.