Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe
Validation of screening tools for depression and anxiety disorders in a primary care population with high HIV prevalence in Zimbabwe
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DOI：
10.1016/j.jad.2016.03.006
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发表时间：
2016-07-01
影响因子：
6.6
通讯作者：
Abas, Melanie
中科院分区：
文献类型：
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作者：
Chibanda, Dixon;Verhey, Ruth;Abas, Melanie
背景：在撒哈拉以南非洲的低收入国家，很少有经过验证的工具来筛查常见的致残性精神障碍，如抑郁症和一般焦虑症（GAD）。目的：我们验证了三种筛查工具：常见精神障碍肖纳症状问卷（SSQ-14）、抑郁症患者健康问卷（PHQ-9）和广泛性焦虑障碍问卷（GAD-7）。研究参与者是津巴布韦哈拉雷一家初级卫生保健诊所的参与者。方法：于2013年9月连续招募18岁及以上的成人，为期两周。经过培训的研究助理在获得书面同意后对符合条件的参与者使用筛选工具。然后由四名精神病学家中的一名使用DSM-IV （SCID）的结构化临床访谈对参与者进行访谈。根据SCID作为金标准，计算每个工具的性能特征。结果：共纳入264名受试者，其中52人（20%）符合单纯抑郁的SCID标准，97人（37%）符合混合抑郁和焦虑的SCID标准，9人（3%）符合单纯焦虑的SCID标准。在已知感染艾滋病毒的237人中，有165人（70%）为艾滋病毒阳性。在最佳临界值>= 9的情况下，SSQ-14对抑郁症和/或一般性焦虑诊断的敏感性和特异性分别为84% （95%CI: 78-89%）和73% （95%CI:63-81%）。内部信度高（Cronbach alpha=0.74）。PHQ-9的最佳临界值为>= 11，对于抑郁症的SCID诊断，其敏感性为85% (95%CI:78-90%)，特异性为69% (95%CI:59-77%) （Cronbach alpha=0.86）。GAD-7（最佳截断bb0 = 10）对SCID诊断GAD的敏感性和特异性分别为89% （95%CI:81-94%）和73% (95%CI:65-80%) （Cronbach alpha =0.87）。结论：抑郁症和广泛性焦虑症筛查工具在艾滋病毒高流行的津巴布韦初级卫生保健人群中具有良好的性能特征。这些可以用于研究，也可以用于临床护理，以筛选可能从治疗中受益的患者。(C) 2016 Elsevier B.V.版权所有
Background: In low income countries in Sub-Saharan Africa there are few validated tools to screen for common disabling mental disorders such as depression and general anxiety disorder (GAD).Objectives: We validated three screening tools: the Shona Symptom Questionnaire for common mental disorders (SSQ-14), the Patient Health Questionnaire for depression (PHQ-9), and the Generalized Anxiety Disorder questionnaire (GAD-7). The study participants were attendees at a primary health care clinic in Harare, Zimbabwe.Methods: Consecutive adults aged 18 and above attending the clinic were enrolled over a two-week period in September 2013. Trained research assistants administered the screening tools to eligible participants after obtaining written consent. Participants were then interviewed by one of four psychiatrists using the Structured Clinical Interview of the DSM-IV (SCID). Performance characteristics were calculated for each tool, against the SCID as the gold standard.Results: A total of 264 participants were enrolled, of whom 52 (20%) met the SCID criteria for depression alone, 97 (37%) for mixed depression and anxiety and 9 (3%) for anxiety alone. Of the 237 where HIV status was known, 165 (70%) were HIV positive. With the optimal cutoff of >= 9, the sensitivity and specificity for the SSQ-14 against a diagnosis of either depression and/or general anxiety were 84% (95% CI:78-89%) and 73% (95%CI:63-81%) respectively. Internal reliability was high (Cronbach alpha=0.74). The optimal cutoff for PHQ-9 was >= 11, which provided a sensitivity of 85% (95%CI:78-90%) and specificity of 69% (95%CI:59-77%) against a SCID diagnosis of depression (Cronbach alpha=0.86). The GAD-7 (optimal cutoff >= 10) had sensitivity and specificity of 89% (95%CI:81-94%) and 73% (95%CI:65-80%) respectively against a SCID diagnosis of GAD (Cronbach alpha =0.87).Conclusion: Screening tools for depression and GAD had good performance characteristics in a primary health care population in Zimbabwe with a high prevalence of HIV. These can be used for research and also in clinical care to screen patients who may benefit from treatment. (C) 2016 Elsevier B.V. All rights reserved.