Predictors of psychiatric comorbidity in medical outpatients
Predictors of psychiatric comorbidity in medical outpatients
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DOI：
10.1097/01.psy.0000079379.39918.17
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发表时间：
2003-09-01
影响因子：
3.3
通讯作者：
Herzog, W
中科院分区：
文献类型：
--
作者：
Löwe, B;Gräfe, K;Herzog, W
目的：门诊患者的精神共病与个人痛苦和心理社会功能下降有关。需要简单的临床指标来提高对精神共病的认识和治疗。本研究旨在确定精神共病的预测因素，用于繁忙医疗环境中的诊断用途，并描述其标准有效性。方法：采用 SCID 作为独立判断标准，对 6 个内科门诊和 12 个全科诊所的 357 名患者（68% 女性；平均年龄 43 岁）是否存在精神合并症进行判断。通过患者和医生问卷调查来调查精神共病的潜在指标。使用逻辑回归分析来确定精神合并症的独立预测因素，并确定其操作特征。结果：在 18 个指标中，确定了精神共病的四个最重要的预测因素：紧张、焦虑或忧虑的筛查问题（比值比，11.9；p < .001）、抑郁情绪的筛查问题（比值比，8.8；p < .001）、三种或更多令人烦恼的身体症状的自我报告（比值比，3.2；p = .001），并因伴侣困难而感到苦恼（优势比，2.7；p = .006）。四个预测因子的综合评估得出阳性预测值高达 100%，阴性预测值高达 91%，敏感性高达 86%，特异性高达 100%。结论：通过了解和使用四种易于获取的预测因素，可以大大改善门诊患者精神障碍的识别。当可以确认这些预测因素中的一种或多种的存在时，建议患者接受进一步的评估，以更准确地确定所识别的精神疾病的存在和具体类型。
Objective: Psychiatric comorbidity in medical outpatients is associated with personal suffering and reduced psychosocial functioning. Simple clinical indicators are needed to improve recognition and treatment of psychiatric comorbidity. This study aimed to identify predictors of psychiatric comorbidity for diagnostic use in busy medical settings and to describe their criterion validity. Methods: The SCID was adopted as the independent criterion standard for the presence of a psychiatric comorbidity in 357 patients (68% female; mean age, 43 years) of six internal medicine outpatient clinics and 12 general practices. Potential indicators of psychiatric comorbidity were investigated by means of patient and physician questionnaires. Logistic regression analyses were used to identify independent predictors of psychiatric comorbidity, and their operating characteristics were determined. Results: Of 18 indicators, the four most important predictors of psychiatric comorbidity were identified: a screening question for nervousness, anxiety, or worries (odds ratio, 11.9; p < .001), a screening question for depressed mood (odds ratio, 8.8; p < .001), the self-report of three or more bothersome physical symptoms (odds ratio, 3.2; p = .001), and feeling distressed by partner difficulties (odds ratio, 2.7; p = .006). The combined assessment of the four predictors resulted in positive predictive values as high as 100%, negative predictive values as high as 91%, sensitivities as high as 86%, and specificities as high as 100%. Conclusions: The identification of mental disorders in medical outpatients could be substantially improved by the knowledge and use of four easily accessible predictors. When the presence of one or more of these predictors can be confirmed, it is suggested that the patient undergo further evaluation to determine more precisely the presence and specific type of psychiatric disorder being identified.