10．抑うつに有用な評価指標

抄録

Depression is a common psychiatric disorder that encompasses a wide range of psychological and physical symptoms. Among elderly patients, physical symptoms are particularly prominent, with dizziness being a notable example. For assessing dizziness clinically, otolaryngological examinations should serve as the initial step. If no organic cause is identified, clinicians should consider the potential presence of underlying depression. The diagnosis of depression primarily depends on evaluating psychiatric symptoms through clinical interviews, guided by standardized diagnostic criteria such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). As a preliminary measure prior to formal diagnostic evaluation, self-rating scales for depression provide a convenient tool for screening individuals for the potential presence of depressive symptoms.

Self-reported depression scales are tools for assessing patients’ subjective psychological experiences. Commonly used instruments include the Patient Health Questionnaire-9 (PHQ-9), Zung Self-Rating Depression Scale (SDS), and Beck Depression Inventory (BDI). Each scale offers distinct features tailored to specific purposes, enabling efficient screening for depressive symptoms. However, their application requires careful consideration. In addition to relying on the patient’s cognitive capacity and comprehension, self-reported scales are prone to overestimation/underestimation of the severity of symptoms. Additionally, the inclusion of somatic symptoms in these scales may result in the misattribution of physical symptoms, such as dizziness, as depressive symptoms in patients with comorbid physical illnesses. To improve the diagnostic accuracy, clinician-administered rating scales such as the Hamilton Depression Rating Scale (HAM-D) and Montgomery-Åsberg Depression Rating Scale (MADRS) are recommended. These tools enable a more objective evaluation of depressive symptoms, but require adequate training to ensure proper use. In conclusion, careful selection and application of depression rating scales, aligned with specific clinical objectives, are crucial for effective patient care.