Nease D E, Volk R J, Cass A R
Department of Family Medicine, The University of Texas Medical Branch at Galveston, USA.
J Am Board Fam Pract. 1999 Jan-Feb;12(1):21-31. doi: 10.3122/15572625-12-1-21.
Current Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications describe spectrums of symptoms that define mood and anxiety disorders. These DSM classifications have been applied to primary care populations to establish the frequency of these disorders in primary care. DSM classifications, however, might not adequately describe the underlying or natural groupings of mood and anxiety symptoms in primary care. This study explores common clusters of mood and anxiety symptoms and their severity while exploring the degree of cluster congruency with current DSM classification schemes. We also evaluate how well the groupings derived from these different classifying methods explain differences in patients' health-related quality of life.
Study design was cross-sectional, using a sample of 1333 adult primary care patients attending a university-based family medicine clinic. We applied cluster analysis to responses on a 15-item instrument measuring symptoms of mood and anxiety and their severity. We used the PRIME-MD to determine the presence of DSM-III-R disorders. The SF-36 Health Survey was used to assess health-related quality of life.
Cluster analysis produced four groups of patients different from groupings based on the DSM. These four groups differed from each other on sociodemographic indicators, health-related quality of life, and frequency of DSM disorders. Cluster membership was associated in three of four clusters with a clinically significant and progressive decrease in mental and physical health functioning as measured by the SF-36 Health Survey. This decline was independent of the presence of a DSM diagnosis.
A primary care classification scheme for mood and anxiety symptoms that includes severity appears to provide more useful information than traditional DSM classifications of disorders.
当前的《精神疾病诊断与统计手册》（DSM）分类描述了定义情绪和焦虑障碍的症状谱。这些DSM分类已应用于初级保健人群，以确定这些障碍在初级保健中的发生率。然而，DSM分类可能无法充分描述初级保健中情绪和焦虑症状的潜在或自然分组。本研究探讨了情绪和焦虑症状的常见聚类及其严重程度，同时探讨了聚类与当前DSM分类方案的一致程度。我们还评估了从这些不同分类方法得出的分组在解释患者健康相关生活质量差异方面的效果。
研究设计为横断面研究，使用了1333名在大学附属家庭医学诊所就诊的成年初级保健患者作为样本。我们对一份测量情绪和焦虑症状及其严重程度的15项问卷的回答进行了聚类分析。我们使用PRIME-MD来确定DSM-III-R障碍的存在情况。使用SF-36健康调查来评估健康相关生活质量。
聚类分析产生了四组患者，与基于DSM的分组不同。这四组在社会人口统计学指标、健康相关生活质量和DSM障碍发生率方面彼此不同。在四个聚类中的三个聚类中，聚类成员与通过SF-36健康调查测量的心理和身体健康功能的临床显著且渐进性下降相关。这种下降与是否存在DSM诊断无关。
一种包括严重程度的情绪和焦虑症状初级保健分类方案似乎比传统的DSM障碍分类提供了更有用的信息。
