Sandanger I, Moum T, Ingebrigtsen G, Sørensen T, Dalgard O S, Bruusgaard D
Department of Social Insurance Medicine, University of Oslo, Norway.
Soc Psychiatry Psychiatr Epidemiol. 1999 Jan;34(1):53-9. doi: 10.1007/s001270050112.
In previous analyses of data from the present general population study we found that screening of anxiety and depression symptoms by the Hopkins Symptom Checklist-25 (HSCL-25) and diagnostic classification by the Composite International Diagnostic Interview (CIDI) identified the same amount of cases, but agreed in only half of them. In this paper we compared and validated the screening cases with the classificatory cases by the use of medication, loss of functioning and help seeking (illness indicators). We thought that the CIDI cases would have more illness indicators, because they reflected diagnoses, "true illness", in contrast to the HSCL-25, which was a more unspecific measure of distress. The HSCL-25 and the illness indicators data were collected in a stage I random individual population sample above 18 years during 1989-1991 (N = 1879, response rate 74%), the CIDI data were collected in a selected stage II, (N = 606, response rate 77%). The stage II data were weighted to represent the population sample. Screening cases by the HSCL-25 had significantly more illness indicators than diagnostic cases by the CIDI. Cases agreed upon with both instruments had the most illness indicators, cases agreed upon only by the CIDI had the least. Diagnoses give information about help eventually needed, the HSCL-25 distress measure expresses more the urgency with which it is needed. The choice between the HSCL-25 and the CIDI would depend on the aim and the resources of the study. If evaluation of needs is involved, using an instrument picking up both classification and distress would be the best choice. Given our positive experience with interviewing with the CIDI, a CIDI improved to be more sensitive to how much distress a certain diagnosis exerts on the individual would be a good choice.
在对本次普通人群研究的数据进行的先前分析中，我们发现，通过霍普金斯症状清单25项（HSCL - 25）筛查焦虑和抑郁症状以及通过复合国际诊断访谈（CIDI）进行诊断分类所识别出的病例数量相同，但两者仅在一半的病例上达成一致。在本文中，我们通过使用药物治疗、功能丧失和寻求帮助（疾病指标）来比较并验证筛查病例和分类病例。我们认为，CIDI病例会有更多的疾病指标，因为它们反映的是诊断，即“真正的疾病”，这与HSCL - 25不同，HSCL - 25是对痛苦的一种更不具特异性的衡量。HSCL - 25和疾病指标数据是在1989 - 1991年期间从18岁以上的第一阶段随机个体人群样本中收集的（N = 1879，应答率74%），CIDI数据是在选定的第二阶段收集的（N = 606，应答率77%）。第二阶段的数据经过加权以代表总体样本。通过HSCL - 25筛查出的病例比通过CIDI诊断出的病例有更多的疾病指标。两种工具都认可的病例有最多的疾病指标，仅被CIDI认可的病例有最少的疾病指标。诊断提供了最终所需帮助的信息，HSCL - 25的痛苦衡量指标更多地表达了所需帮助的紧迫性。在HSCL - 25和CIDI之间的选择将取决于研究的目的和资源。如果涉及需求评估，使用一种既能进行分类又能衡量痛苦的工具将是最佳选择。鉴于我们在使用CIDI进行访谈方面有积极的经验，一种经过改进以对特定诊断给个体带来的痛苦程度更敏感的CIDI将是一个不错的选择。
