Comparative Responsiveness and Minimally Important Difference of Common Anxiety Measures
Comparative Responsiveness and Minimally Important Difference of Common Anxiety Measures
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DOI：
10.1097/mlr.0000000000001185
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发表时间：
2019-11-01
期刊：
影响因子：
3
通讯作者：
Lourens, Spencer G.
中科院分区：
文献类型：
--
作者：
Kroenke, Kurt;Baye, Fitsum;Lourens, Spencer G.
背景：焦虑是最普遍的精神障碍之一，并占大量的残疾以及增加的医疗保健费用。本研究探讨了最小重要差异（MID）和反应性的6个常用的焦虑量表。研究方法：样本包括294名来自单一VA医疗中心的6个初级保健诊所的患者，他们参加了一项治疗慢性肌肉骨骼疼痛和共病抑郁和/或焦虑的远程护理试验。评估的指标为患者报告结局测量信息系统（PROMIS）4项、6项和8项焦虑量表;广泛性焦虑障碍7项量表（GAD-7）;症状自评量表焦虑子量表（SCL）;创伤后应激障碍自评量表（PCL）;简明量表（SF）-36心理健康子量表;以及SF-12心理成分总结（MCS）。有效性进行了评估，这些措施相互之间的相关性，并与生活质量和残疾的措施。MID是通过对几种方法进行三角测量来估计的。通过比较：（a）3个月时报告情绪好转、相同或恶化的患者的标准化反应均值;（B）改善（好转）与未改善（相同/恶化）患者的曲线下面积。结果如下：收敛和结构效度的支持，强相关性的焦虑措施与彼此和适度的相关性与生活质量和残疾的措施，分别。所有指标均区分了3个月时报告总体改善的患者与无变化的患者，但无法区分恶化与无变化。曲线下面积显示量表的反应性相当。PROMIS量表的MID估计值为4; GAD-7为3; PCL为6; SF-36心理健康子量表为9; MCS评分为5，SCL焦虑量表为0.3。结论：六种常用的焦虑量表表现出相似的反应性，估计的MID可用于衡量临床研究和实践中的焦虑变化。
Background: Anxiety is one of the most prevalent mental disorders and accounts for substantial disability as well as increased health care costs. This study examines the minimally important difference (MID) and responsiveness of 6 commonly used anxiety scales. Methods: The sample comprised 294 patients from 6 primary care clinics in a single VA medical center who were enrolled in a telecare trial for treatment of chronic musculoskeletal pain and comorbid depression and/or anxiety. The measures assessed were the Patient Reported Outcomes Measurement Information System (PROMIS) 4-item, 6-item, and 8-item anxiety scales; the Generalized Anxiety Disorder 7-item scale (GAD-7); the Symptom Checklist anxiety subscale (SCL); the Posttraumatic Stress Disorder Checklist (PCL); the Short Form (SF)-36 Mental Health subscale; and the SF-12 Mental Component Summary (MCS). Validity was assessed with correlations of these measures with one another and with measures of quality of life and disability. MID was estimated by triangulating several methods. Responsiveness was evaluated by comparing: (a) the standardized response means for patients who reported their mood as being better, the same, or worse at 3 months; (b) the area under the curve for patients who had improved (better) versus those who had not (same/worse). Results: Convergent and construct validity was supported by strong correlations of the anxiety measures with one another and moderate correlations with quality of life and disability measures, respectively. All measures differentiated patients who reported global improvement at 3 months from those who were unchanged, but were less able to distinguish worsening from no change. The area under the curves showed comparable responsiveness of the scales. The estimated MID was 4 for the PROMIS scales; 3 for the GAD-7; 6 for the PCL; 9 for the SF-36 mental health subscale; 5 for the MCS score, and 0.3 for the SCL anxiety scale. Conclusions: Six commonly used anxiety scales demonstrate similar responsiveness, and estimated MIDs can be used to gauge anxiety change in clinical research and practice.