Screening for Mental Health Problems: Addressing the Base Rate Fallacy for a Sustainable Screening Program in Integrated Primary Care
Screening for Mental Health Problems: Addressing the Base Rate Fallacy for a Sustainable Screening Program in Integrated Primary Care
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DOI：
10.1093/jpepsy/jsw048
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发表时间：
2016-11-01
影响因子：
3.6
通讯作者：
Meyers, Kathryn Mendelsohn
中科院分区：
文献类型：
--
作者：
Lavigne, John V.;Feldman, Marissa;Meyers, Kathryn Mendelsohn
目的《平价医疗法案》激发了人们对初级保健中心理问题筛查的兴趣。考虑到筛查可能发生的规模，需要考虑被称为基本比率谬论的问题的含义。方法探讨敏感性和特异性、阳性预测值和阴性预测值、基本率谬误等概念。筛选程序在随机选择的基础上可能无法改进的可能性，以及顺序筛选可能有用的可能性。结果和讨论制定有效的儿童心理健康问题筛查方案是非常可取的，正确解决高假阳性率可能会提高此类方案能够持续的可能性。需要考虑使用顺序筛选，这种方法既有优点也有缺点，这取决于要筛选的问题的类型和是否有资源进行后续评价。
Objective The Affordable Care Act has stimulated interest in screening for psychological problems in primary care. Given the scale with which screening might occur, the implications of a problem known as the base rate fallacy need to be considered. Methods The concepts of sensitivity and specificity, positive and negative predictive value, and the base rate fallacy are discussed. The possibility that a screening program may not improve upon random selection is reviewed, as is the possibility that sequential screening might be useful. Results and Discussion Developing effective screening programs for pediatric mental health problems is highly desirable, and properly addressing the high rate of false positives may improve the likelihood that such programs can be sustained. Consideration needs to be given to the use of sequential screening, which has both advantages and disadvantages, depending upon the type of problem to be screened for and the availability of resources for follow-up evaluations.