KISEP Original Articles 38 1 1999 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
결론 : 중심단어 서론 49
1. 번역및예비연구 1) GDS 의번역 연구방법 2) 예비연구 50
2. 본연구 1) 연구대상 2) 연구방법 3) 면담도구 51
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4) 자료분석 연구결과 53
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 65.486.19 65.406.22 65.276.16 Sex Male 2933 925.7 2039.2 Female 5967 2674.3 3160.8 Educationyears None 2234.3 1234.3 917.6 16 3337.5 1440 1937.3 79 1112.5 2 5.7 917.6 1012 1011.4 3 8.6 611.8 Above 13 1213.6 411.4 815.7 No. of case having current 4753.4 1851.4 2752.9 physical disorder No. of case living with spouse 6978.4 3085.7 3976.5 Mean score of MMSE-K 25.403.83 24.943.21 25.714.26 1. 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
Table 3. Comparison of GDS scoresmeans.d. among different groups Major Non major Total subject depression depression P N88 N35 N51 Item 1 # 0.490.50 0.570.50 0.410.50 n Item 2 # 0.820.39 0.970.17 0.710.46 * Item 3 # 0.490.50 0.740.17 0.290.46 ** Item 4 # 0.550.50 0.860.36 0.310.47 ** Item 5 0.520.50 0.800.36 0.370.49 ** Item 6 0.520.50 0.830.38 0.310.47 ** Item 7 # 0.670.47 0.800.41 0.590.50 * Item 8 # 0.560.50 0.710.46 0.430.50 * Item 9 # 0.530.50 0.830.38 0.310.47 ** Item 10 # 0.490.50 0.890.32 0.200.40 ** Item 11 0.480.50 0.770.43 0.250.44 ** Item 12 # 0.420.50 0.630.49 0.290.46 * Item 13 0.490.50 0.740.44 0.310.47 ** Item 14 # 0.560.50 0.710.46 0.430.50 * Item 15 # 0.520.50 0.890.32 0.250.44 ** Item 16 0.610.49 0.800.41 0.470.50 * Item 17 # 0.410.49 0.690.47 0.200.40 ** Item 18 0.360.48 0.570.50 0.240.43 ** Item 19 0.650.48 0.940.24 0.430.50 ** Item 20 0.740.44 0.890.32 0.630.49 * Item 21 # 0.780.41 0.860.36 0.730.45 n Item 22 # 0.510.50 0.830.38 0.270.45 ** Item 23 # 0.420.50 0.690.47 0.220.42 ** Item 24 0.570.50 0.690.47 0.510.51 n Item 25 0.440.50 0.690.47 0.250.44 ** Item 26 0.590.49 0.740.44 0.470.50 * Item 27 0.580.50 0.710.46 0.490.51 * Item 28 0.430.50 0.690.47 0.250.44 ** Item 29 0.640.48 0.690.47 0.590.50 n Item 30 0.760.43 0.800.41 0.730.45 n Total 16.638.07 23.004.50 11.966.83 ** SGDS 8.224.53 11.662.65 5.653.85 ** 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 1 0.5134** 0.2999 0.6704** Item 2 0.5290** 0.1550 0.4861** Item 3 0.6438** 0.5463** 0.5063** Item 4 0.7370** 0.3320 0.6848** Item 5 0.5890** 0.5163** 0.4661** Item 6 0.5567** 0.1370 0.4412** Item 7 0.4857** 0.1775 0.6135** Item 8 0.5145** 0.3000 0.5142** Item 9 0.7261** 0.3254 0.6973** Item 10 0.7515** 0.6288** 0.4993** Item 11 0.5922** 0.4764* 0.3426* Item 12 0.4445** 0.4541* 0.3218* Item 13 0.5219** 0.3692* 0.3787* Item 14 0.4089** 0.0857 0.3855* Item 15 0.7439** 0.5882** 0.5421** Item 16 0.6729** 0.3227 0.7546** Item 17 0.7075** 0.5978** 0.5942** Item 18 0.4948** 0.5347** 0.3700* Item 19 0.7130** 0.0834 0.6722** Item 20 0.3624** 0.0609 0.2773* Item 21 0.4541** 0.3135 0.5290** Item 22 0.6516** 0.4966* 0.4322* Item 23 0.6024** 0.3336* 0.4893** Item 24 0.4427** 0.3892* 0.5509** Item 25 0.5922** 0.2502 0.5488** Item 26 0.5259** 0.3101 0.5397** Item 27 0.3591** 0.3000 0.3130* Item 28 0.5499** 0.5422** 0.3559* Item 29 0.3034* 0.4727* 0.2425 Item 30 0.3195* 0.2581 0.3861* Note. *p.05, **p.001. 55
Table 5. Item-total correlation in SGDS Major Non major Total subject depression depression N88 N35 N51 Item 1 0.5686** 0.5505** 0.6521** Item 2 0.5391** 0.1090 0.5158** Item 3 0.7099** 0.7000** 0.5788** Item 4 0.7781** 0.4787* 0.7275** Item 7 0.5164** 0.4000* 0.5912** Item 8 0.4336** 0.1352 0.4128* Item 9 0.7424** 0.4054* 0.7053** Item 10 0.8007** 0.6417** 0.6285** Item 12 0.4905** 0.5793** 0.3757* Item 14 0.4184** 0.0866 0.4025* Item 15 0.7476** 0.4694* 0.5969** Item 17 0.7500** 0.6192** 0.5192** Item 21 0.4480** 0.2908 0.5293** Item 22 0.7128** 0.6090** 0.5236** Item 23 0.6284** 0.3831* 0.4893** 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. 14.9429.5686.0571.4314.6000.9355.4694 15.9429.6471.0571.3529.6471.9429.5504 16.9429.6863.0571.3137.6735.9459.5920 17 a.9429.7451.0571.2549.7174.9500.6556 18.9143.7843.0857.2157.7442.9302.6744 19 b.9143.8235.0857.1765.7805.9333.7185 20.8571.8627.1429.1373.8108.8980.7135 21.7714.8824.2286.1176.8182.8491.6597 22.6286.8824.3714.1176.7857.7759.5275 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
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. 6.9429.5490.0571.4510.5893.9333.4496 7.9429.6471.0571.3529.6471.9429.5504 8 a.9429.7255.0571.2745.7021.9487.6342 9.8857.7647.1143.2353.7209.9070.6279 10 b.8571.8627.1429.1373.8108.8980.7135 11.7143.8627.2857.1373.7813.8148.5849 12.6000.9216.4000.0784.8400.7705.5460 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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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 correlatedr0.9594 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
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