Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires
Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires
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DOI：
10.1017/s0033291707002334
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发表时间：
2008-02-01
影响因子：
6.9
通讯作者：
Weiss, H. A.
中科院分区：
文献类型：
--
作者：
Patel, V.;Araya, R.;Weiss, H. A.
背景。在初级护理管理计划中，需要对患者进行常见精神疾病（CMD）筛查。这项研究旨在比较五份广泛使用的问卷的筛选特性。通过系统抽样招募了印度五个主要护理环境中的成年人。与参与者的随机顺序进行了四个问卷：一般健康问卷（GHQ，12个项目）；初级健康问卷（PHQ，九项）；凯斯勒的心理困扰量表（K10，10个项目），我们可以从中提取较短的6个项目K6的得分；以及自我报告问卷（SRQ，20个项目）。对所有参与者进行了结构化的诊断访谈，修订后的临床访谈时间表（CIS-R）。可用于598名参与者的完整数据（参与率为99.3％）。所有五个问卷都表现出中度至高歧视能力。 GHQ和SRQ显示出最佳结果。这五个均显示出中度至高度的相关性，最贫穷的是两份最短的问卷K6和PHQ之间的相关性。这五个具有相对良好的内部一致性。然而，与诊断访谈相比，问卷的正预测价值（PPV）在最佳临界分数下的诊断访谈范围从51％至77％不等。这些问卷的准确识别案件的能力几乎没有差异，但是没有任何敏感性妥协的较高的PPV。因此，选择最佳截止分数可能需要根据各个设置来量身定制灵敏度和PPV之间的最佳平衡，并且在资源有限的初级护理设置中建议使用更高的截止值。
Background. Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.Method. Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).Results. Complete data were available for 598 participants (participation rate 99.3 %). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51 % to 77 % at the optimal cut-off scores.Conclusions. There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.