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基层医疗中的实用心理健康评估。快速心理诊断小组的有效性和实用性。

Practical mental health assessment in primary care. Validity and utility of the Quick PsychoDiagnostics Panel.

作者信息

Shedler J, Beck A, Bensen S

机构信息

Digital Diagnostics, Inc, Aspen, Colorado, USA.

出版信息

J Fam Pract. 2000 Jul;49(7):614-21.

Abstract

BACKGROUND

Many case-finding instruments are available to help primary care physicians (PCPs) diagnose depression, but they are not widely used. Physicians often consider these instruments too time consuming or feel they do not provide sufficient diagnostic information. Our study examined the validity and utility of the Quick PsychoDiagnostics (QPD) Panel, an automated mental health test designed to meet the special needs of PCPs. The test screens for 9 common psychiatric disorders and requires no physician time to administer or score.

METHODS

We evaluated criterion validity relative to the Structured Clinical Interview for DSM-IV (SCID), and evaluated convergent validity by correlating QPD Panel scores with established mental health measures. Sensitivity to change was examined by readministering the test to patients pretreatment and posttreatment. Utility was evaluated through physician and patient satisfaction surveys.

RESULTS

For major depression, sensitivity and specificity were 81% and 96%, respectively. For other disorders, sensitivities ranged from 69% to 98%, and specificities ranged from 90% to 97%. The depression severity score correlated highly with the Beck, Hamilton, Zung, and CES-D depression scales, and the anxiety score correlated highly with the Spielberger State-Trait Anxiety Inventory and the anxiety subscale of the Symptom Checklist 90 (Ps <.001). The test was sensitive to change. All PCPs agreed or strongly agreed that the QPD Panel "is convenient and easy to use," "can be used immediately by any physician," and "helps provide better patient care." Patients also rated the test favorably.

CONCLUSIONS

The QPD Panel is a valid mental health assessment tool that can diagnose a range of common psychiatric disorders and is practical for routine use in primary care.

摘要

背景

有许多病例发现工具可帮助初级保健医生(PCP)诊断抑郁症,但这些工具并未得到广泛应用。医生通常认为这些工具耗时过长,或者觉得它们无法提供足够的诊断信息。我们的研究检验了快速心理诊断(QPD)面板的有效性和实用性,这是一种旨在满足初级保健医生特殊需求的自动化心理健康测试。该测试可筛查9种常见精神疾病,且无需医生花费时间进行施测或评分。

方法

我们相对于《精神疾病诊断与统计手册》第四版(DSM-IV)的结构化临床访谈(SCID)评估了标准效度,并通过将QPD面板得分与既定的心理健康测量指标进行关联来评估收敛效度。通过对患者治疗前和治疗后重新进行测试来检验对变化的敏感性。通过医生和患者满意度调查来评估实用性。

结果

对于重度抑郁症,敏感性和特异性分别为81%和96%。对于其他疾病,敏感性范围为69%至98%,特异性范围为90%至97%。抑郁严重程度得分与贝克、汉密尔顿、zung和CES-D抑郁量表高度相关,焦虑得分与斯皮尔伯格状态-特质焦虑量表以及症状自评量表90的焦虑分量表高度相关(P<0.001)。该测试对变化敏感。所有初级保健医生都同意或强烈同意QPD面板“方便易用”、“任何医生都可立即使用”以及“有助于提供更好的患者护理”。患者对该测试的评价也很高。

结论

QPD面板是一种有效的心理健康评估工具,可诊断一系列常见精神疾病,适用于初级保健的常规使用。

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