Medical co-morbidity and validity of DSM-IV depression criteria.

摘要: Background. Clinicians have questioned the validity of depression criteria in patients with chronic medical illness, but few empirical data address this question. Method. Computerized records identified two samples managed care beginning treatment: 235 diabetes, ischemic heart disease, or obstructive lung disease and 204 without those conditions. Telephone assessments at baseline, 2 months, 6 months included Structured Clinical Interview for DSM-IV other measures severity functional status. Item Response Theory analyses compared patterns depressive symptoms across groups specifically evaluated somatic (fatigue, change weight appetite, psychomotor agitation/retardation, sleep disturbance) as indicators depression. Logistic regression examined how during treatment varied between patient groups. Results. Overall item response analysis indicated differential functioning (Χ =33.7, df=18, p=0.017). Two eight item-level comparisons were statistically significant; one predicted direction (patients co-morbidity reported more fatigue low levels depression: Χ =17.9, df= 1, p<0.001) opposite from less agitation/retardation =8.0, df=1, p=0.005). Observed differences modest: midpoint scale, had a 54% probability reporting to 45 % co-morbidity. All four showed robust improvement treatment, did not differ significantly Conclusions. We find only limited evidence that fatigue, changes disturbance are valid illness. diagnosis do require significant modification