Why GHQ threshold varies from one place to another
Why GHQ threshold varies from one place to another
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DOI：
10.1017/s0033291798006874
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发表时间：
1998-07-01
影响因子：
6.9
通讯作者：
Ormel, J
中科院分区：
文献类型：
--
作者：
Goldberg, DP;Oldehinkel, T;Ormel, J
背景资料。对于不同环境下GHQ所采用的最佳阈值的不同，尚无令人信服的解释。世卫组织最近的一项研究对15个城市的GHQ和CIDI数据进行了进一步的分析。单项诊断或多项诊断的CIDI症状的平均数量在不同城市之间没有差异。然而，最佳阈值被发现与一个中心的单一诊断和多个诊断的流行率有关。包括在“黄金标准”中的诊断差异并不能解释观察到的差异。ROC曲线下面积(作为GHQ的辨别力的衡量标准)与最佳阈值之间有很强的关系，阈值越高，GHQ的表现越好。GHQ-12中区分病例和非病例的条目因中心不同而不同。GHQ阈值部分取决于多项诊断的流行率，较高的阈值与较高的单项和多项诊断率相关。所有受访者的平均GHQ得分为最佳门槛提供了粗略的指导。在总部的歧视性力量最低的中心，有必要使用低门槛，以确保敏感性得到保护，但温室总部的阳性预测值则较低。中心之间的一些差异是由于不同物品的歧视性力量不同造成的。
Background. No convincing explanation has been forthcoming for the variation in best threshold to adopt for the GHQ in different settings.Methods. Data dealing with the GHQ and the CIDI in 15 cities from a recent WHO study was subjected to further analysis.Results. The mean number of CIDI symptoms for those with single diagnoses, or those with multiple diagnoses, does not vary between cities. However, the best threshold is found to be related to the prevalence both of single and of multiple diagnoses in a centre. Variations in the diagnoses to be included in the 'gold standard' did not account for the variation observed. There was a strong relationship between area under the ROC curve (as a measure of the discriminatory power of the GHQ) and the best threshold, with higher thresholds being associated with superior performance of the GHQ. The items on the GHQ-12 that provided most discrimination between cases and non-cases varied from one centre to another.Conclusions. The GHQ threshold is partly determined by the prevalence of multiple diagnoses, with higher thresholds being associated by higher rates of both single and multiple diagnosis. The mean GHQ score for the whole population of respondents provides a rough guide to the best threshold. In those centres where the discriminatory power of the GHQ is lowest, it is necessary to use a low threshold as a way of ensuring that sensitivity is protected, but the positive predictive Value of the GHQ is then lower. Some of the variation between centres is due to variation in the discriminatory power of different items.