Screening for depression and anxiety disorders in primary care patients
Screening for depression and anxiety disorders in primary care patients
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DOI：
10.1002/da.20274
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发表时间：
2007-01-01
影响因子：
7.4
通讯作者：
Bunevicius, Robertas
中科院分区：
文献类型：
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作者：
Bunevicius, Adomas;Pecelluniene, Jurate;Bunevicius, Robertas
情绪和焦虑症在初级卫生保健中非常普遍。在这项研究中，我们评估了医院焦虑和抑郁量表(HADS)在筛查初级保健患者群体中抑郁和焦虑症方面的表现。共有503名连续入住立陶宛考纳斯初级保健医疗中心的初级保健患者完成了这项研究。我们发现，HADS抑郁量表(HADS-D)在以6分或以上为界值时，对迷你国际神经精神病学访谈(MINI)诊断的重大抑郁发作的筛查效果最好，其敏感性为80%，特异性为69%，阳性预测值为80%，阴性预测值为92%，受试者操作特征(ROC)曲线下面积为0.75。HADS-D对心境恶劣的微型诊断能力较弱。HADS焦虑量表(HADS-A)以9分或以上为界值时，对总体焦虑症的微小诊断表现最佳，其敏感性为77%，特异性为75%，阳性预测值为53%，阴性预测值为90%，ROC曲线下面积为0.76。这些结果表明，在初级保健患者中，HADS是一种适当的筛查工具，可以用于严重抑郁发作的微型诊断，但不适用于以6分为临界值的恶劣心境障碍和以9分为临界值的焦虑症。
Mood and anxiety disorders are highly prevalent in primary health care. In this study we assessed performance of the Hospital Anxiety and Depression Scale (HADS) for screening of depression and anxiety disorders in a population of primary care patients. A total of 503 primary care patients consecutively admitted to the primary care medical center in Kaunas, Lithuania, completed the study. We found that the HADS subscale of depression (HADS-D) at a cutoff score of 6 or more showed the best performance screening for a major depressive episode diagnosed by means of the Mini International Neuropsychiatric Interview (MINI), with a sensitivity of 80%, specificity of 69%, positive predictive value of 80%, negative predictive value of 92%, and area under the receiver operating characteristic (ROC) curve of 0.75. Performance of the HADS-D against MINI diagnosis of dysthymia was weak. The HADS subscale of anxiety (HADS-A) at a cutoff score of 9 or more showed the best performance screening for MINI diagnosis of overall anxiety disorders, with a sensitivity of 77%, specificity of 75%, positive predictive value of 53%, negative predictive value of 90%, and area under the ROC curve of 0.76. These results suggest that in primary care patients HADS is an adequate screening instrument for the MINI diagnoses of major depressive episode, but not for dysthymia at a cutoff score of 6, and for anxiety disorders at a cutoff score of 9.