在初级保健中临床诊断抑郁症:一个元分析
Alex J Mitchell1, Amol Vaze, Sanjay Rao
1Leicestershire Partnership Trust, Leicester General Hospital, Leicester, UK. Alex.Mitchell@leicspart.nhs.uk
Lancet (London, England)
|July 31, 2009
概括
一般医生 (GPs) 在初级保健中经常误诊抑郁症. 随着时间的推移,重新评估可以提高全科医生对抑郁症诊断的准确性,减少错误阳性和错过病例.
科学领域:
- 主要的护理是初级护理.
- 心理健康 心理健康
- 诊断的准确性 诊断的准确性
背景情况:
- 抑郁症对全球的健康造成了重大负担.
- 一般医生 (GPs) 是抑郁症护理的主要提供者.
- 在初级保健中准确诊断抑郁症至关重要,但具有挑战性.
研究的目的:
- 评估全科医生对无辅助抑郁症诊断的准确性.
- 确定初级保健抑郁症诊断中的真阳性,真阴性,假阳性和假阴性率.
- 确定影响诊断准确性的因素.
主要方法:
- 118项关于GP抑郁症诊断准确性的研究的元分析.
- 包括41项具有强有力的结果标准的研究 (结构化/半结构化访谈).
- 分析诊断准确度指标,包括灵敏度,特异性和预测值.
主要成果:
- 在47.3%的病例中,全科医生正确识别了抑郁症.
- 积极的预测值为42.0%,负的预测值为85.8%.
- 每100名患者中,假阳性病例 (15) 超过了遗漏病例 (10) 或确定的病例 (10).
结论:
- 一般医生可以有效地排除非抑郁个体的抑郁症.
- 在初级保健中抑郁症的低患病率导致更多的错误识别比错过的病例.
- 与单次评估相比,前性,扩展性评估 (3-12个月) 可以提高诊断准确性.
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