KISEP Original Articles J Korean Neuropsychiatr Assoc Vol 38, No 1 DSM-III-R 주요우울증에대한한국어판 Geriatric Depression Scale(GDS) 의진단적타당성연구 * 조맹제 1)

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1 KISEP Original Articles J Korean Neuropsychiatr Assoc Vol 38, No 1 DSM-III-R 주요우울증에대한한국어판 Geriatric Depression Scale(GDS) 의진단적타당성연구 * 조맹제 1) 배재남 2) 서국희 3) 함봉진 4) 김장규 5) 이동우 1) 강민희 2) 국문초록 연구목적 : Validation of Geriatric Depression Scale, Korean VersionGDS in the Assessment of DSM-III-R Major Depression* Maeng Je Cho, M.D., 1) Jae Nam Bae, M.D., 2) Guk Hee Suh, M.D., 3) Bong Jin Hahm, M.D., 4) Jang Kyu Kim, M.D., 5) Dong Woo Lee, M.D., 1) Min Hee Kang, M.D. 2) 방법 : 결과 : Department of Psychiatry, College of Medicine, Seoul National University, Seoul Department of Psychiatry, College of Medicine, Inha University, Inchon Department of Psychiatry, Hankang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul Department of Psychiatry, Chungnung Evangelical Hospital Department of Psychiatry, Yonchon Medical Center Corresponding author 48

2 결론 : 중심단어 서론 49

3 1. 번역및예비연구 1) GDS 의번역 연구방법 2) 예비연구 50

4 2. 본연구 1) 연구대상 2) 연구방법 3) 면담도구 51

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6 4) 자료분석 연구결과 53

7 Table 1. Comparison of clinical variables between the two groups, major depression group and non major depression group Total subject N88 N% Major depression N35 N% Non major depression N51 N% AgemeanSD Sex Male Female Educationyears None Above No. of case having current physical disorder No. of case living with spouse Mean score of MMSE-K 한국어판 GDS의신뢰도검증 1) 내적일관성 (Internal consistency) 2. 한국어판 GDS의타당도검증 1) 한국어판 GDS와다른우울측정검사도구와의상관관계 Table 2. Correlations of the GDS with other depression scales GDS SGDS CES-D HRS-D MMSE-K GDS 1.000*.9594*.7415*.7788*.0541 SGDS 1.000*.6933*.7490*.0974 CES-D 1.000*.7949*.0659 HRS-D 1.000*.1057 MMSE-K 1.000* Note*p.001 2) 주요우울증환자군과비주요우울증환자군과의문항별점수및총점비교 54

8 Table 3. Comparison of GDS scoresmeans.d. among different groups Major Non major Total subject depression depression P N88 N35 N51 Item 1 # n Item 2 # * Item 3 # ** Item 4 # ** Item ** Item ** Item 7 # * Item 8 # * Item 9 # ** Item 10 # ** Item ** Item 12 # * Item ** Item 14 # * Item 15 # ** Item * Item 17 # ** Item ** Item ** Item * Item 21 # n Item 22 # ** Item 23 # ** Item n Item ** Item * Item * Item ** Item n Item n Total ** SGDS ** pp-value in T-test for GDS score between major depression group and non major depression group *p.05, **p.001, nnon-significant # indicates items of SGDS Table 4. Item-total correlation in GDS Total subject N88 Major depression N35 Non major depression N51 Item ** ** Item ** ** Item ** ** ** Item ** ** Item ** ** ** Item ** ** Item ** ** Item ** ** Item ** ** Item ** ** ** Item ** * * Item ** * * Item ** * * Item ** * Item ** ** ** Item ** ** Item ** ** ** Item ** ** * Item ** ** Item ** * Item ** ** Item ** * * Item ** * ** Item ** * ** Item ** ** Item ** ** Item ** * Item ** ** * Item * * Item * * Note. *p.05, **p

9 Table 5. Item-total correlation in SGDS Major Non major Total subject depression depression N88 N35 N51 Item ** ** ** Item ** ** Item ** ** ** Item ** * ** Item ** * ** Item ** * Item ** * ** Item ** ** ** Item ** ** * Item ** * Item ** * ** Item ** ** ** Item ** ** Item ** ** ** Item ** * ** Note. *p.05, **p.001 3) 각문항의변별도분석 Table 6. The values of accuracy indices according to various cut-off scores of the GDS Cut-off SE SP FNR FPR PPV NPV Kappa a b Note. Cut-offCut-off score, SESensitivity, SPSpecificity, TPRTrue positive rate, FNRFalse negative rate, FPRFalse positve rate, PPVPositive predictive value, NPVNegative predictive value, Kappa.Kappa value a Optimal cut-off score estimated to screen major depression b Cut-off score indicated by ROC curve analysis 3. 최적절단점의추정 56

10 Table 7. The values of accuracy indices according to various cut-off scores of the SGDS Cut-off SE SP FNR FPR PPV NPV Kappa a b Note. Cut-offCut-off score, SESensitivity, SPSpecificity, TPRTrue positive rate, FNRFalse negative rate, FPRFalse positve rate, PPVPositive predictive value, NPVNegative predictive value, Kappa.Kappa value a Optimal cut-off score estimated to screen major depression b Cut-off score indicated by ROC curve analysis Fig. 1. ROC curve analysis depicting SGDS, GDS, CES-D, HRS-D indicates optimal cutoff point, GDS19, SGDS10 4. ROC커브분석법에의한, 우울증선별검사들의주요우울증진단 (DSM-III-R) 에대한진단적타당성분석 고찰 57

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13 참고문헌 1) Weissmann MM, Bruce ML, Leaf PJ(1991):Affective disorder. In;LE Robins and DA Regier, eds. Psychiatric disorder in America:The Epidemiologic Catchment Area Study, The Free Press, New York 2) Koenig HG, Blazer DG(1992):Epidemiology of geriatric affective disorders. Clin Geriatr Med 8: ) 조맹제, 김계희 (1993): 주요우울증환자예비평가에서 CES-D의진단적타당도연구. 신경정신의학 32: ) 김광일 (1977): 우울증의증후학적연구. 제1편 : Hamilton 우울증측정표의적응을위한연구. 신경정신의학 16: ) 송옥헌 (1977): 정신과외래환자의 the Self-Rating Depression Scale(SDS) 에관한연구. 신경정신의학 16: ) 신승철, 김만권, 윤관수, 김진학, 이명선, 문수재, 이민준, 이호영, 유계준 (1991) : 한국에서의 the Center for Epidemiologic studies Depression Scale (CES-D) 의사용 : 표준화및요인구조에대한횡문화적검토. 신경정신의학 30: ) 한홍무, 염태호, 신영우, 김교헌, 윤도준, 정근재 (1986):Beck depression inventory의한국판표준화연구. 신경정신의학 25: ) Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO(1983):Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiat Res 17: ) Kahn RL, Zarit SH, Hilbert LM, Niederehe G (1975):Memory complaint and impairment in the aged:the effect of depression and altered brain function. Arch Gen Psychiatry 32: ) Salzman C, Shader RI(1978):Depression in the elderly:relationship between depression, psychologic defense mechanism and physical illness. J Am Geriat Soc 26: ) Wells CE(1979):Pseudodementia. Am J Psychiatry 136: ) Sheikh VI, Yesavage VA(1986):Geriatric Depression Scale(GDS):Recent evidence and development of shorter version. In TL Brink(Ed), Clinical Gerontology;A guide to assessment and intervention, New York Haworth Press, pp ) Alden D, Austin C, Sturgeon R(1989):A correlation between the geriatric depression scale long and short forms. Journal of Gerontology 44: ) Cwikel J, Ritchie K(1988):The short GDS:Evaluation in a heterogeneous, multilingual population. Clinical Gerontologist 8:

14 15) Lesher EL, Berryhill JS(1994):Validation of the geriatric depression scale-short form among inpatients. J of Clin Psychol 50: ) Hamilton M(1960):Rating depressive patients. J Clin Psychiatry 41: ) Robins LN, Helzer JE, Croughan J, Ratcliff KS (1981):National Institute of Mental Health Diagnostic Interview Schedule:It s history, characteristics and validity. Arch Gen Psychiatry 38: ) 조맹제, 함봉진, 주진형, 배재남, 권준수 (1998): 일도시지역사회노인들의인지기능장애와우울증상의유병율. 신경정신의학 37: ) 권용철, 박종한 (1989): 노인용한국판 Mini-Mental State Examination(MMSE-K) 의표준화연구 - 제1편 : MMSE-K의개발-. 신경정신의학 28 : ) 이정균, 김용식, 한진희, 최진옥 (1986): 한국정신장애의역학적조사연구 (VII)-한국어판 DIS의제작-. 서울의대정신의학 11( 부록 ), pp ) Hyer L, Blount J(1984):Concurrent and discriminant validities of the geriatric depression scale with older psychiatric inpatients. Psychol Rep 54: ) Norris JT, Gallaghter D, Wilson A, Winograd CH (1987):Assessment of Depression in Geriatric Medical Outpatients;The validity of two screening measures. J Am Geriatr Soc 35: ) Zgourides G, Spofford M, Doppelt L(1989):The Geriatric Depression Scale;Discriminant validity and elderly daytreatment clients. Psycho Rep 64: ) Lesher EL(1986):Validation of the geriatric depression scale among nursing home residents. Clinical Gerontologist 4: ) McGivney SA, Mulvihill M, Taylor B(1994):Validation of GDS depression screen in the nursing home. J Am Geriatr Soc 42: ) Koenig H, Meador KG, Cohen HG, Blazer DG (1988):Self-rated depression scale and screening for major depression in older hospitalized patients with medical illness. J Am Geriatr Soc 36: ) Gerety MB, Williams Jr JW, Mulrow CD, Cornell JE, Kadri AA, Rosenberg J, Chiodo LK, Long M (1994):Performance of case-finding tools for depression in nursing home:influence of clinical and functional characteristics and selection of optimal threshold scores. J Am Geriatr Soc 42: ) Radolf LS(1977):The CES-D Scale:A report depression scale for research in general population. Apple Psychol Measurement 1: ) Radloff LS, Locke BZ(1986):The community mental health survey and CES-D scale:in community survey of psychiatric disoreder. Edited by Weissmann MM, Myers JD, Ross CE. New Burniswick NJ. Ruters university press 30) Eaton WW, Kessler LG(1981):Rate of symptoms of deprssion in a national sample. Am J Epidemiol 114: ) Hamilton M(1967):Development of rating scale for primary depressive illness. Br J of Soc & Clin Psychology 6: ) Folstein MF, Folstein SE, McHugh PR(1975): Mini-mental state:a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: ) Murphy JM, Berwick DM, Weinstein MC, Borus JF, Budman SH, Klerman GL(1987):Performance of screening and diagnostic tests:application of receiver operating characteristics analysis. Arch Gen Psychiatry 44: ) Weinstein MC, Berwick DM, Goldman PA, Murphy JM, Barsky AJ(1989):A comparison of three psychiatric screening test using receiver operating characteristics(roc) analysis. Med Care 27: ) Gavin DR, Ross HE, Skinner HA(1989):Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorder. Br J Addiction 84: ) Hsaio JK, Bartko JJ, Potter WZ(1989):Diagnosing diagnoses:receiver operating characteristic methods and psychiatry. Arch Gen Psychiatry 46: ) Hanley JA, McNeil BJ(1983):A method of comparing the areas under receiver operating curves derived from the same cases. Radiology 149: ) Sackett DL, Haynes RB, Tugwell P(1991):Clinical epidemiology:a basic science for clinical medicine, 2nd edition. Little Brown and company, Boston 39) Husaini BA, Neff JA, Harrington JB, Houghes MD, Stone RH(1980):Depression in rural communities: Validating the CES-D scale. J Community Psychology 8:

15 ABSTRACT J Korean Neuropsychiatr Assoc Vol 38, No 1, January, 1999 Validation of Geriatric Depression Scale, Korean VersionGDS in the Assessment of DSM-III-R Major Depression Maeng Je Cho, M.D., Jae Nam Bae, M.D., Guk Hee Suh, M.D., Bong Jin Hahm, M.D., Jang Kyu Kim, M.D., Dong Woo Lee, M.D., Min Hee Kang, M.D. Department of Psychiatry, College of Medicine, Seoul National University, Seoul ObjectivesThe authors attempted to evaluate the diagnostic validity of the Korean version, Geriatric Depression ScaleGDS for screening geriatric DSM-III-R major depression among clinical populations. MethodsThrough of preliminary trials 3 times, the authors translated GDS including Short form Geriatric Depression ScaleSGDS into Korean. GDS, SGDS, HRS-D, CES-D was adminis-tered to 88 elderly psychiatric patients35 major depressives, 51 were non-major depression and also Diagnostic Interview ScheduleDIS-III-R was administered independently to diagnoses DSM-III-R major depression. Reliability and validity test 5, optimal cut-off point estimation, and ROC curve analysis were done to investigate the diagnostic validity of GDS and SGDS. ResultsInternal consistency-reliability and concurrent validity of GDS, SGDS associated with other depression scaleshrs-d, CES-D were excellent. Content validity and discriminant validity which differentiate DSM-III-R major depression from non-major depression was also good. The authors suggest the score 17as the optimal cut-off point of GDS for screening DSM-III-R major depression among clinical populations and the score 8as optimal cut-off score of SGDS. ROC curve analysis revealed wide AUC of both GDS and SGDS, which indicates its high diagnostic validity in assessing DSM-III-R major depression. The GDS and SGDS were found to be highly correlatedr and any difference of AUC between both scales in ROC curve analysis were not found. This finding suggests that SGDS can be an adequate substitute for GDS. ConclusionThe GDS and SGDS are valid and reliable case finding tools for screening DSM-III- R major depression among clinical populations in Korea but relatively high cut-off point demands the further evaluation in the viewpoint of culturally determined style of response for the depression questionnaire in Korea. KEY WORDSGDS SGDS Major depression Elderly Diagnostic validity Optimal cut-off score. 62

16 부록 #1.? #2.? #3.? #4.? 5.? 6.? #7.? #8.? #9.? #10.? 11.? #12.? 13.? #14.? #15.? 16.? #17.? 18.? 19.? 20.? #21.? #22.? #23.? 24.? 25.? 26.? 27.? 28.? 29.? 30.? Note# indicates items of Short form GDSSGDS 63

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012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar