柯氏憂鬱量表應用於篩選國人更年期婦女憂鬱症之適用性

Ko Depression Inventory as a Screening Tool for Detecting Clinical Depression among Climacteric Women in Taiwan

以臨床診斷為效標，修訂更年期「柯氏憂鬱量表」版本，並探討其使用在篩選更年期婦女憂鬱症之信效度與不同切截點之適用性。自台南市東、西、北三區的40～60歲婦女，經分區抽取共5個里進行第一階段取樣共360位，排除手術停經者44位，資料完整填答者為316位。第二階段則邀請316位婦女進行臨床診斷晤談，完成者共199位更年期婦女。本研究先以柯氏憂鬱量表進行憂鬱情緒狀態評估，再對各參與者以半結構化晤談表進行診斷晤談，以確立臨床憂鬱診斷。原完整版量表經項目分析後，修訂成十四題版本，其具有良好之內部一致性與效標效度，且可用於更年期婦女憂鬱症高危險群之篩選，能區辨達臨床診斷標準之憂鬱症者與非憂鬱症者。應用於憂鬱症篩選時，以10分為最理想切截點，敏感性為84.6%，特異性達84.9%，而正確性則達85.4%，顯示簡式修正版具良好信效度。本研究另建立了不同切截點之敏感性與特異性等數值，以供不同篩選目的之參考。

The study was designed to evaluate the appropriateness of the Ko Depression Inventory (KDI) as a screening tool for detecting depression among climacteric women in Taiwan. By using cluster sampling, 360 participants were collected from three district officials. We excluded 161 participants who were illiterate as well as those with surgically induced menopause due to hysterectomy and/or bilateral ovariectomy. The final sample was 199 women, aged 40 to 60 years, recruited from the community. We used the Ko Depression Inventory and the Chinese version of the Modified Schedule of Affective Disorders and Schizophrenia-Lifetime for assessment and data collection. Moreover, each woman underwent a face-to-face semi-structured diagnostic interview to obtain her lifetime psychiatric history. Through item-analyses, the KDI was revised into a 14-item version with an internal consistency of 0.84 and split-half reliability of 0.79. Using a cut-off point of 10, the revised KDI showed the sensitivity of 84.6% and specificity of 84.9% in prospectively detecting major depression disorder and dysthymic disorder among climacteric women in Taiwan. The Short-Form version of KDI with favorable reliability and validity proved a good screening tool for depression among climacteric women in Taiwan. The appropriateness of various cut-off scores of the KDI was also evaluated in this study.