Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil.
Comparing mental health semi-structured diagnostic interviews and symptom checklists to predict poor life outcomes: an 8-year cohort study from childhood to young adulthood in Brazil.
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DOI：
10.1016/s2214-109x(23)00462-x
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发表时间：
2024-01
影响因子：
34.3
通讯作者：
Salum, Giovanni Abrahao
中科院分区：
文献类型：
--
作者：
Hoffmann, Mauricio Scopel;Pine, Daniel S.;Georgiades, Katholiki;Szatmari, Peter;Miguel, Euripedes Constantino;Pan, Pedro Mario;Gadelha, Ary;Rohde, Luis Augusto;Merikangas, Kathleen Ries;Milham, Michael Peter;Satterthwaite, Theodore Daniel;Salum, Giovanni Abrahao
半结构化的诊断性访谈和症状清单呈现出类似的内部可靠性。我们的目标是调查它们在预测从童年到青年时期的不良生活结果方面是否存在差异。在这项纵向研究中，我们使用了来自巴西儿童精神健康状况高危队列研究的数据。符合条件的参与者在入学当天(2010年1月至2月)年龄为6-14岁，并由巴西阿雷格里港和S的亲生父母在公立学校入学。在2010-11年对2511名年轻人及其照顾者进行了基线评估，8年后对1917人进行了评估(2018-19年；76.3%的保留率)。临床阈值是根据《精神疾病诊断和统计手册》、《发育和幸福感评估》和《儿童行为检查表》(CBCL；T-Score≥70被认为是阳性病例)定义的临床评分通过半结构化家长报告访谈得出的。在8岁时，参与者被评估为综合的危及生命的结果(包括死亡、自杀未遂、严重自残、精神科住院或急诊科就诊)和综合的低生活机会结果(包括任何刑事定罪、滥用药物或辍学)。我们评估了DAWBA和CBCL预测这些结果的准确性。Logistic回归模型根据年龄、性别、种族或民族、研究地点和社会经济阶层进行了调整。DAWBA和CBCL对综合结果及其组成部分具有相似的敏感性、特异性、预测值和测试准确性。根据DAWBA和CBCL的分类，任何精神健康问题都与威胁生命的综合结局独立相关(DAWBA调整后的优势比1·62，95%可信区间1·20-2·18；CBCL 1·66，1·19-2·30)，但只有CBCL独立预测不良的生活机会(1.56，1.19-2.04)。与仅按DAWBA或CBCL分类的参与者相比，按这两种方法分类的参与者发生危及生命的结果的几率并不高，而与仅按CBCL分类的参与者相比，生命机会结局较差的参与者并不更高。根据半结构诊断性访谈对儿童和青少年进行分类，在测试准确性和相关生活结果的预测有效性方面与症状检查表没有统计学差异。根据症状清单进行分类可能是一种有效的替代方法，可以替代昂贵和耗时的方法来识别面临不良生活结果风险的年轻人。国家技术发展委员会；S圣保罗医学研究基金会；欧洲研究理事会医学研究理事会。摘要的葡萄牙语译文见补充资料部分。
Semi-structured diagnostic interviews and symptom checklists present similar internal reliability. We aim to investigate whether they differ in predicting poor life outcomes in the transition from childhood to young adulthood. For this longitudinal study, we used data from the Brazilian High Risk Cohort Study for Childhood Mental Health Conditions. Eligible participants were aged 6–14 years on the day of study enrolment (January to February, 2010) and were enrolled in public schools by a biological parent in Porto Alegre and São Paulo, Brazil. 2511 young people and their caregivers were assessed at baseline in 2010–11, and 1917 were assessed 8 years later (2018–19; 76·3% retention). Clinical thresholds were derived using semi-structured parent-report interview based on the Diagnostic and Statistical Manual of Mental Disorders, according to the Developmental and Well-being Assessment (DAWBA), and clinical scores as defined by the Child Behavior Checklist (CBCL; T-score ≥70 considered positive caseness). At 8 years, participants were assessed for a composite life-threatening outcome (a composite of death, suicide attempts, severe self-harm, psychiatric inpatient admission, or emergency department visits) and a composite poor life chances outcome (a composite of any criminal conviction, substance misuse, or school dropout). We evaluated the accuracy of DAWBA and CBCL to predict these outcomes. Logistic regression models were adjusted for age, sex, race or ethnicity, study site, and socioeconomic class. DAWBA and CBCL had similar sensitivity, specificity, predictive values, and test accuracy for both composite outcomes and their components. Any mental health problem, as classified by DAWBA and CBCL, was independently associated with the composite life-threatening outcome (DAWBA adjusted odds ratio 1·62, 95% CI 1·20–2·18; CBCL 1·66, 1·19–2·30), but only CBCL independently predicted poor life chances (1·56, 1·19–2·04). Participants classified by both approaches did not have higher odds of the life-threatening outcome when compared with participants classified by DAWBA or CBCL alone, nor for the poor life chances outcome when compared with those classified by CBCL alone. Classifying children and adolescents based on a semi-structured diagnostic interview was not statistically different to symptom checklist in terms of test accuracy and predictive validity for relevant life outcomes. Classification based on symptom checklist might be a valid alternative to costly and time-consuming methods to identify young people at risk for poor life outcomes. Conselho Nacional de Desenvolvimento Científico e Tecnológico; Fundação de Amparo à Pesquisa do Estado de São Paulo; and Medical Research Council, European Research Council. For the Portuguese translation of the abstract see Supplementary Materials section.