Abstract: Background　Depression has become one of the most important mental diseases that endanger the physical and mental health of the elderly，and how to prevent and control the depression symptoms of the elderly effectively has become the focus of social attention.At present，the depression characteristics of the elderly are mainly measured by psychological scales.Objective　To explore the application of Tree-Drawing Test（TDT）in the screening of depression among the elderly in communities，providing the new ideas for screening elderly depression patients in China.Methods　Random sampling method was used to select 160 elderly people from Jiangbin Xincun Community，Zhenjiang City，Jiangsu Province from October 1，2018 to June 15，2019 as the research objects，and were divided to Normal group（n=97），mild depression group（n=53），moderate and severe depression group（n=10） according to their GDS-15 scores.This study used general information questionnaires（gender，age，education level，marital status，living conditions，chronic medical history and recreational activities，etc），GDS-15，TDT（Qualitative indicators such as whole tree smear，canopy droop，trunk smear，trunk bottom closed，smeared tree bases，etc.Quantitative indicators such as the height and width of the entire tree，the height and width of the crown，the height and width of the trunk，the occupied area，etc）were evaluated for the elderly in the community，drawing the receiver operating characteristic curve（ROC curve）of TDT depression dimension to analyze the diagnostic value of TDT for depression.Results　There were statistically significant differences in the education level，living conditions and recreational activities of the elderly among the three groups（P<0.05） and there were no statistically significant differences in the whole tree smear，canopy droop，trunk smear，trunk bottom closed，smeared tree bases，height and width of the trunk among the three groups of elderly in the community（P>0.05）.There were statistically significant differences in the height and width of the entire tree，the height and width of the crown，and the occupied area of the elderly among the three groups of elderly in the communities（P<0.05）.The height and width of the entire tree，the height and width of the crown，and the occupied area in mild depression group，moderate and severe depression group are all smaller than the normal group（P<0.05）.The optimal cut-off value of the area occupied by TDT in the diagnosis of depression was 40 S.At this point，the sensitivity and specificity were 72.3% and 81.7%，respectively，and the area under the ROC curve was 0.790.Conclusion　TDT has high sensitivity and specificity in the diagnosis of depression，and it has high application value in the screening of depression among the elderly in the community.

Key words: Depressive disorder, Tree-drawing test, Aged, The Geriatric Depression Scale, Sensitivity, Specificity

摘要： 背景　抑郁症已成为影响老年人身心健康的重要精神疾病之一，如何有效地预防与控制老年人抑郁症已成为当今社会关注的焦点。目前主要通过心理量表测评老年人的抑郁情况，但对老年抑郁患者进行画树测验（TDT）的定量研究鲜有报道。目的　探索TDT在社区老年人抑郁症筛查中的应用情况，为我国老年人抑郁症筛查提供新思路。方法　采用随机抽样法选取2018-10-01至2019-06-15江苏省镇江市江滨新村社区老年人160例作为研究对象，并根据其老年人抑郁量表（GDS-15）评分情况分为正常组（97例），轻度抑郁组（53例），中、重度抑郁组（10例）。采用一般资料问卷（性别、年龄、文化程度、婚姻状况、居住情况、慢性病史及文娱活动等）、GDS-15、TDT（定性指标包括整棵树涂抹、树冠下垂、树干涂抹、树干底部封闭、树基涂抹等，定量指标包括整棵树高度与宽度、树冠高度与宽度、树干高度与宽度、占用面积等）对社区老年人进行评价。绘制TDT中占用面积诊断抑郁症的受试者工作特征（ROC）曲线，分析TDT对抑郁症的诊断价值。结果　3组社区老年人文化程度、居住情况、文娱活动情况比较，差异均有统计学意义（P<0.05）。3组社区老年人整棵树涂抹、树冠下垂、树干涂抹、树干底部封闭、树基涂抹、树干高度和宽度比较，差异均无统计学意义（P>0.05）。3组社区老年人整棵树高度和宽度、树冠高度和宽度、占用面积比较，差异均有统计学意义（P<0.05）；其中轻度抑郁组及中、重度抑郁组的整棵树高度和宽度、树冠高度和宽度、占用面积均小于正常组（P<0.05）。TDT中占用面积诊断抑郁症的最佳截断值为40 S，此时其灵敏度、特异度分别为72.3%、81.7%，ROC曲线下面积为0.790。结论　TDT诊断抑郁症具有较高的灵敏度、特异度，其在社区老年人抑郁症筛查中有较高的应用价值。

关键词: 抑郁症, 画树测验, 老年人, 老年抑郁量表, 灵敏度, 特异度