Depression is highly prevalent and one of the major contributors to disability worldwide. However, one of the findings from the DSM-5 field trials was that inter-rater reliability for diagnosing major depressive disorder was very poor. Why is diagnosing MDD so challenging? This article attempts to explain why undefined pathogenesis and complicated phenotypes complicate the diagnosis of MDD. However, further biomarker and translational research is still necessary to help clinicians screen and diagnose depression in the future rather than relying solely on current subjective diagnostic criteria.
抑郁症非常普遍，也是全球范围导致残疾的主 要原因之一。然而，DSM-5 现场测试发现诊断抑郁症 （major depressive disorder, MDD）的评估者间信度是 很差的。为什么诊断MDD 如此具有挑战性？本文尝试 阐明为什么抑郁症发病机制的不确定性和表现形式的 复杂性会使诊断变得困难。然而，将来仍然需要其他 的生物标志物和转化医学研究来帮助临床医生筛选和 诊断抑郁症，而不是单纯依靠目前的主观性诊断标准。.
Keywords: biomarker; depression; diagnosis; pathogenesis; phenotype.