Comparative validity of screening instruments for mental distress in zambia.
Comparative validity of screening instruments for mental distress in zambia.
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DOI：
10.2174/1745017901006010004
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发表时间：
2010-01-27
期刊：
影响因子：
--
通讯作者：
Fylkesnes K
中科院分区：
文献类型：
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作者：
Chipimo PJ;Fylkesnes K
由于认识到心理健康是造成全球疾病负担的一个主要因素，因此越来越多的人要求将心理健康服务纳入初级保健和社区健康调查，以改善对精神痛苦的筛查、诊断和治疗。现在有许多筛查工具。然而，在发展中国家，这些工具检测精神痛苦的文化有效性很少被调查。在这些国家，受过训练的工作人员和专门的精神病设施有限，妨碍了精神保健服务的改善。因此，迫切需要开发一种快速、低成本、不需要专门培训的筛查仪器。我们在赞比亚卢萨卡的初级卫生保健诊所就诊者中验证了不同的完善的筛查工具。我们还评估了SRQ的面孔，内容和标准效度，并确定了最常见的精神困扰症状。筛选工具，SRQ-20，SRQ-10和GHQ-12被用作彼此的并行标准，并与金标准，DSM-IV进行比较。评估其相关性、敏感性和特异性。所有的工具管理400初级卫生保健诊所的与会者。还对其中28名诊所参加者进行了深入访谈。SRQ-20和SRQ-10都具有正确识别精神痛苦的高性能，AUC分别为0.96和0.95，而GHQ-12具有中等性能（AUC，0.81）。SRQ和GHQ-12的最佳临界点分别为7和3。SRQ也被发现有良好的表面和内容效度。 该研究确立了SRQ-20用于检测精神困扰病例的实用性，并强调了验证工具以适应目标人群的重要性。它还证实SRQ-10是赞比亚初级保健设施中第一个可靠的简明易用的精神痛苦筛查工具。
The recognition of mental health as a major contributor to the global burden of disease has led to an increase in the demand for the inclusion of mental health services in primary health care as well as in community-based health surveys in order to improve screening, diagnosis and treatment of mental distress. Many screening instruments are now available. However, the cultural validity of these instruments to detect mental distress has rarely been investigated in developing countries. In these countries, limited trained staff and specialized psychiatric facilities hamper improvement of mental health services. It is therefore imperative to develop a quick, low cost screening instrument that does not require specialized training. We validated different well established screening instruments among primary health care clinic attendees in Lusaka, Zambia. We also assess the face, content and criterion validity of the SRQ’s and determined the most commonly reported symptoms for mental distress. The screening instruments, SRQ-20, SRQ-10 and GHQ-12 were used as concurrent criteria for each other and compared against a gold standard, DSM-IV. Their correlation, sensitivity and specificity were assessed. All instruments were administered to 400 primary health care clinic attendees. In-depth interviews were also conducted with 28 of these clinic attendees. Both the SRQ-20 and SRQ-10 had high properties for identifying mental distress correctly with an AUC of 0.96 and 0.95 respectively while the GHQ-12 had modest properties (AUC, 0.81). The optimum cut-off points for this population were 7 and 3 for the SRQ and GHQ-12 respectively. The SRQ was also found to have good face and content validity. The study establishes the utility of the SRQ-20 for detecting mental distress cases and also underscores the importance of validating instruments to suit the context of the target population. It also validates the SRQ-10 as the first reliable abbreviated and easy-to-use screening instrument for mental distress in primary health care facilities in Zambia.