Originales
Diseño y validación de un cuestionario para la detección de depresión mayor en pacientes ancianos
Design and validation of a questionnaire for the detection of major depression in elderly patients
Jesús D. López-Torres-Hidalgoa,b,
, M. Pilar Galdón Blesac, Clotilde Fernández-Olanoa,c, Francisco Escobar-Rabadánb,c, Julio Montoya-Fernándezb,c, Clotilde Boix-Grasd, María J. Montes-Lozanob,e, Luis Víctor Blas-Hernándeze, María L. Cremades-Romeroe, José M. del Campo-del Campoc, Francisco Arnalich-Fernándezf,g
Autor para correspondencia
jesusl@sescam.org
Correspondencia: Jesús López-Torres Hidalgo. Gerencia de Atención Primaria. Marqués de Villores, 6. 02001 Albacete. España.
Correspondencia: Jesús López-Torres Hidalgo. Gerencia de Atención Primaria. Marqués de Villores, 6. 02001 Albacete. España.
a Gerencia de Atención Primaria de Albacete. España
b Facultad de Medicina. Universidad de Castilla-La Mancha. Albacete. España
c Centro de Salud Universitario Zona IV de Albacete. España
d Unidad Docente de Medicina Familiar y Comunitaria. Albacete. España
e Complejo Hospitalario Universitario. Albacete. España
f Facultad de Medicina. Universidad Autónoma de Madrid. Madrid. España
g Hospital Universitario La Paz. Madrid. España
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España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Unidad Docente de Medicina Familiar y Comunitaria. Albacete. España" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] 4 => array:3 [ "entidad" => "Complejo Hospitalario Universitario. Albacete. España" "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff5" ] 5 => array:3 [ "entidad" => "Facultad de Medicina. Universidad Autónoma de Madrid. Madrid. España" "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff6" ] 6 => array:3 [ "entidad" => "Hospital Universitario La Paz. Madrid. España" "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff7" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Jesús López-Torres Hidalgo. Gerencia de Atención Primaria. Marqués de Villores, 6. 02001 Albacete. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Design and validation of a questionnaire for the detection of major depression in elderly patients" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2004-06-09" "fechaAceptado" => "2004-10-28" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec16935" "palabras" => array:5 [ 0 => "Atención primaria" 1 => "Trastornos depresivos" 2 => "Validez" 3 => "Fiabilidad" 4 => "Cuestionarios" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec16934" "palabras" => array:5 [ 0 => "Primary care" 1 => "Depressive disorders" 2 => "Validity" 3 => "Reliability" 4 => "Questionnaires" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento y objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]).</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (α de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background and objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]).</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews).</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:41 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gabinete Gabinete de Estudios Sociológicos Bernard Krief. Estudio Sociosanitario. Libro Blanco. La calidad asistencial de la depresión en España. 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13074364
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