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STABILITY OF PSYCHIATRIC SYMPTOMS IN PRIMARY CARE PTS

初级保健患者精神症状的稳定性

基本信息

批准号：
6135420
负责人：
DAVID ARTHUR KATERNDAHL
金额：
$ 5.97万
依托单位：
UNIVERSITY OF TEXAS SAN ANTONIO
依托单位国家：
美国
项目类别：
财政年份：
2000
资助国家：
美国
起止时间：
2000-04-01 至 2001-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/6135420
关键词：
behavioral /social science research tag clinical research diagnosis quality /standard health care referral /consultation health services research tag human subject interview mental disorder diagnosis patient care management psychometrics sign /symptom stress

项目摘要

There is growing concern among primary care physicians that the DSM system does not accurately reflect mental health problems seen in primary care. Primary care patients are frequently judged by their primary care physician to be psychologically distressed and functionally impaired; yet they do not meet DSM criteria for a mental disorder. However, studies using the DSM system are cited as evidence that primary care physicians fail to recognize mental health problems, do not optimally treat those they recognize, and need to refer such patients to mental health professionals. The purpose of this pilot study is to test the methods and estimate statistical parameters needed for conducting a longitudinal primary care-based study assessing the accuracy and clinical validity of the DSM classification system in primary care settings. This study will measure recruitment and dropout rates using three follow-up strategies. It will also determine optimal timing for qualitative interviews and whether there are differences based upon baseline "distress". This longitudinal primary care based pilot study will follow 100 Hispanic and non-Hispanic white patients over a 6-month period. Excluding patients with DSM disorders using a modified SCID screening module or those on psychotropics at baseline, 50 distressed and 50 non-distressed patients matched on the number of chronic medical problems will undergo baseline assessment including the Brief Social Desirability Scale. Baseline and monthly interviews will include identification of common DSM disorders via the SCID, measurement of levels of anxiety, depression, and somatization via the SCL-R, assessment of distress via the GHQ-12, assessment of recent acute illnesses, measurement of functional status using the SF-36, identification of life stresses using the Holmes and Rahe scale and the Daily Hassles Scale, measurement of hope and support via the Herth Hope Index and the DUSOCS respectively, and assessment of alcohol use via the AUDIT. Monthly follow-up interviews will occur using one of three follow-up strategies. Additionally, 16 balanced qualitative interviews will be performed to determine optimal timing of interviews and assess validity of quantitative assessments. Analysis of temporal relationships will rely upon latent growth curve analysis. In addition, the study will identify which follow-up strategy produces the highest follow-up rate and whether baseline "distress" is an important inclusion criterion. This pilot study will also assess response bias via method of interview, levels of symptomatology corresponding to classification thresholds, and the relationship between social desirability and variation over time.

初级保健医生越来越担心 DSM 系统不能准确反映初级保健中出现的心理健康问题。初级保健患者经常被其初级保健医生判断为心理困扰和功能障碍；但他们不符合 DSM 精神障碍标准。然而，使用 DSM 系统的研究被引用作为证据，表明初级保健医生未能识别心理健康问题，没有对他们识别的问题进行最佳治疗，并且需要将此类患者转介给心理健康专业人员。本试点研究的目的是测试进行基于初级保健的纵向研究所需的方法并估计统计参数，以评估初级保健环境中 DSM 分类系统的准确性和临床有效性。本研究将使用三种后续策略来衡量招募率和退出率。它还将确定定性访谈的最佳时机以及是否存在基于基线“困扰”的差异。这项基于初级保健的纵向试点研究将在 6 个月的时间内跟踪 100 名西班牙裔和非西班牙裔白人患者。排除使用改良 SCID 筛查模块患有 DSM 疾病的患者或基线时服用精神药物的患者，根据慢性医疗问题的数量匹配的 50 名痛苦患者和 50 名非痛苦患者将接受基线评估，包括简短的社会期望量表。基线和每月访谈将包括通过 SCID 识别常见的 DSM 疾病，通过 SCL-R 测量焦虑、抑郁和躯体化水平，通过 GHQ-12 评估痛苦，评估最近的急性疾病，使用 SF-36 测量功能状态，使用 Holmes 和 Rahe 量表和每日烦恼量表识别生活压力，通过 Herth Hope 指数和分别通过 DUSOCS 和 AUDIT 评估酒精使用情况。每月的后续访谈将使用三种后续策略之一进行。此外，还将进行 16 次平衡的定性访谈，以确定访谈的最佳时机并评估定量评估的有效性。时间关系的分析将依赖于潜在增长曲线分析。此外，该研究还将确定哪种随访策略能产生最高的随访率，以及基线“痛苦”是否是一个重要的纳入标准。这项试点研究还将通过访谈方法、与分类阈值相对应的症状水平以及社会期望与随时间变化之间的关系来评估反应偏差。