Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review.
Validated Screening Tools for Common Mental Disorders in Low and Middle Income Countries: A Systematic Review.
复制标题
DOI：
10.1371/journal.pone.0156939
复制
发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
De Silva MJ
中科院分区：
文献类型：
--
作者：
Ali GC;Ryan G;De Silva MJ
目前有多种筛查工具可用于检测常见精神障碍(CMD)，但很少有专门针对中低收入国家(LMIC)人群开发的筛查工具。筛查工具的跨文化应用需要根据黄金标准的诊断性面试来评估其有效性。已经在几个LMIC中进行了简单的CMD筛查工具的验证研究，但到目前为止，还没有对所有LMIC人群中所有CMD的筛查工具进行审查。进行了一项具有广泛纳入标准的系统评价，对用于LMIC人群的简要CMD筛查工具进行了全面总结。对于每个验证，诊断优势比(DOR)被计算为筛查工具有效性的一个容易比较的衡量标准。对每个筛查工具计算按样本量加权的平均DOR结果，使我们能够就最佳筛查工具提出广泛的建议。153项研究符合我们的纳入标准。由于许多研究验证了两个或更多筛查工具，这对应于273个对照黄金标准诊断标准的单独验证。我们发现，在多个环境和人群中测试的每个筛查工具的有效性在不同研究之间有所不同，这突显了本地验证的重要性。许多表现最好的工具是专门为特定人群开发的；然而，由于这些工具只在一项研究中得到验证，不可能就它们在其他情况下的适用性得出更广泛的结论。在已在多种环境中验证的工具中，作者广泛推荐使用SRQ-20筛查一般CMD，使用GHQ-12筛查有身体疾病的人群的CMD，使用HADS-D筛查抑郁障碍，使用PHQ-9筛查识字水平较好的人群的抑郁障碍，使用EPDS筛查围产期抑郁障碍，使用HADS-A筛查焦虑症。我们建议，只要有可能，所选的筛查工具应根据黄金标准诊断评估在其将被使用的特定背景下进行验证。
A wide range of screening tools are available to detect common mental disorders (CMDs), but few have been specifically developed for populations in low and middle income countries (LMIC). Cross-cultural application of a screening tool requires that its validity be assessed against a gold standard diagnostic interview. Validation studies of brief CMD screening tools have been conducted in several LMIC, but until now there has been no review of screening tools for all CMDs across all LMIC populations. A systematic review with broad inclusion criteria was conducted, producing a comprehensive summary of brief CMD screening tools validated for use in LMIC populations. For each validation, the diagnostic odds ratio (DOR) was calculated as an easily comparable measure of screening tool validity. Average DOR results weighted by sample size were calculated for each screening tool, enabling us to make broad recommendations about best performing screening tools. 153 studies fulfilled our inclusion criteria. Because many studies validated two or more screening tools, this corresponded to 273 separate validations against gold standard diagnostic criteria. We found that the validity of every screening tool tested in multiple settings and populations varied between studies, highlighting the importance of local validation. Many of the best performing tools were purposely developed for a specific population; however, as these tools have only been validated in one study, it is not possible to draw broader conclusions about their applicability in other contexts. Of the tools that have been validated in multiple settings, the authors broadly recommend using the SRQ-20 to screen for general CMDs, the GHQ-12 for CMDs in populations with physical illness, the HADS-D for depressive disorders, the PHQ-9 for depressive disorders in populations with good literacy levels, the EPDS for perinatal depressive disorders, and the HADS-A for anxiety disorders. We recommend that, wherever possible, a chosen screening tool should be validated against a gold standard diagnostic assessment in the specific context in which it will be employed.