At the Core of Depression: A Diagnostic Interview of the Core Features of Depression.

INTRODUCTION: Valid and reliable methods for diagnosing depression are essential. The present study aimed to test the performance of a new diagnostic interview for depression focusing on the core symptoms of depression. METHOD: We developed a diagnostic interview for depression: the CORE Diagnostic Interview, CORE-DI, which assesses each of the core features of depression on the four dimensions: quality, reactivity, globality, and fluctuations over time. The diagnostic performance of this interview was tested in a clinical study including 83 individuals presenting with various depressive symptoms, who were interviewed independently (1) by means of the CORE-DI and the Mini-International Neuropsychiatric Interview (M.I.N.I.), and (2) by highly skilled specialists in depression representing gold standard diagnoses. RESULTS: We compared the outcome of the CORE-DI, the M.I.N.I., and the diagnosis made by clinicians, respectively, versus the gold standard diagnosis, using diagnostic efficiency statistics. The CORE-DI diagnosed depression with a high specificity (0.91, 95% CI: 0.85-0.97, for International Classification of Diseases [ICD]-10 criteria and 0.88, 95% CI: 0.81-0.95, for Diagnostic and Statistical Manual of Mental Disorders [DSM-5] criteria) compared to both M.I.N.I (specificity 0.44, 95% CI: 0.33-0.55) and clinical diagnoses (specificity 0.76, 95% CI: 0.67-0.85). The sensitivity of the CORE-DI was 0.61 (95% CI: 0.55-0.72) for ICD-10 criteria and 0.67 (95% CI: 0.57-0.77) for DSM-5 criteria. DISCUSSION/CONCLUSION: The CORE-DI increased the specificity of the depression diagnosis substantially compared to clinical diagnoses and the diagnoses obtained by M.I.N.I. The results point to the usefulness of an elaborated and systematic assessment of the core symptoms in the examination of patients with depressive symptoms and thereby indicate a way for further development of specific diagnostic tools for depression in both clinical and research settings. However, it should be noted that the sensitivity of the CORE-DI was modest, and the psychometric properties of the CORE-DI might be different in other settings with higher or lower prevalence or severity of depressive symptoms.

[Large differences in treatment of depression between departments of psychiatry]. / Stor forskel i behandling af depression mellem psykiatriske afdelinger.

INTRODUCTION: A large proportion of patients admitted to psychological departments and wards suffer from depression. Knowledge is limited about the clinical aspects and treatment of depression at admission and discharge, as well as about the differences between psychiatric hospitals. The purpose of this study was to develop a database for patients admitted to a psychiatric department comprising registration of central clinical parameters. MATERIAL AND METHODS: A group of senior psychiatrists with research experience selected 12 central clinical and treatment parameters. All five hospitals in the Copenhagen area participated. Centralised training in the use of Hamilton Depression Rating Scale (HDRS) was performed. At discharge the scores on the various parameters were reported to a central database. RESULTS: The educational HDRS ratings for the departments were rather uniform. The HDRS ratings and Beck Depression Inventory (BDI) ratings at admission and discharge were rather uniform between the participating departments. A large proportion of patients had depressive symptoms at discharge. The most prevalent antidepressants were newer selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors. Much variability was found in the use of medical augmentation strategies and in electroconvulsive therapy (ECT). CONCLUSION: The severity of depression at admission and discharge were uniform across the participating departments. Many patients suffered from depressive symptoms at discharge. Much variability was found in the use of medical augmentation strategies and ECT.