STABILITY OF PSYCHIATRIC SYMPTOMS IN PRIMARY CARE PTS

在初级保健医生中，越来越多的人担心DSM系统不能准确反映初级保健中看到的精神健康问题。初级保健患者经常被他们的初级保健医生判断为心理困扰和功能受损；但他们不符合DSM对精神障碍的标准。然而，使用DSM系统的研究被引用为证据，表明初级保健医生未能认识到精神健康问题，没有对他们认识到的患者进行最佳治疗，并且需要将这些患者转介给精神卫生专业人员。本初步研究的目的是测试方法和估计进行纵向初级保健研究所需的统计参数，以评估初级保健设置中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聘率和辍学率。它还将确定定性访谈的最佳时机，以及基于基线“痛苦”是否存在差异。这项以纵向初级保健为基础的试点研究将对100名西班牙裔和非西班牙裔白人患者进行为期6个月的随访。排除使用改良SCID筛选模块的DSM障碍患者或在基线时服用精神药物的患者，50名慢性医疗问题数量匹配的痛苦患者和50名非痛苦患者将接受基线评估，包括简短社会期望量表。基线和月度访谈将包括通过SCID识别常见DSM障碍，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，分别通过Herth希望指数和DUSOCS测量希望和支持。以及通过审计对酒精使用情况进行评估。每月的随访访谈将采用以下三种随访策略之一。此外，将进行16个平衡的定性访谈，以确定最佳访谈时间和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，该研究将确定哪种随访策略产生最高的随访率，以及基线“窘迫”是否是一个重要的纳入标准。该初步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。

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.