Whetten Kathryn, Reif Susan, Swartz Marvin, Stevens Rachel, Ostermann Jan, Hanisch Laura, Eron Joseph J
Health Inequalities Program, Duke University, Durham, NC 27708, USA.
AIDS Patient Care STDS. 2005 Feb;19(2):89-99. doi: 10.1089/apc.2005.19.89.
Mental illness and substance abuse are common among HIV-infected individuals and are associated with negative outcomes, including poor medication adherence. Therefore, quick and effective methods for detecting these co-occurring disorders are necessary for health care practitioners. This article reports on the creation and preliminary testing of a brief screening tool, the Substance Abuse and Mental Illness Symptoms Screener (SAMISS). The 13-item screener was developed primarily from existing scales and administered to HIV-infected individuals receiving care at infectious diseases clinics in the Southeast. To assess the validity of the SAMISS, a subset of those who screened positive for both mental illness symptoms and substance use problems (n = 207) were administered the Structured Clinical Interview for DSMIV Disorders (SCID). The positive predictive value of the screener in comparison to the SCID was 98.6% for mental disorders and 98.6% for substance use disorders. The agreement between specific screener symptoms and their corresponding SCID diagnoses was relatively high for alcohol dependence (kappa = 0.50, p < 0.001), drug dependence (kappa = 0.30, p < 0.001), and drug abuse (kappa = 0.42, p <0.001). The finding that the screener is highly predictive of having a general mental disorder and substance use disorder among those screening positive for mental illness symptoms and substance use problems, as well as its brevity and ease of administration, make it a useful tool to detect symptoms of co-occurring disorders so that patients can be referred to mental health and substance abuse specialists. The screener is not a diagnostic instrument and has limited value in predicting specific psychiatric diagnoses.
精神疾病和药物滥用在感染艾滋病毒的个体中很常见，并且与包括药物治疗依从性差在内的负面结果相关。因此，对于医疗保健从业者来说，快速有效的方法来检测这些共病是必要的。本文报告了一种简短筛查工具——药物滥用和精神疾病症状筛查器（SAMISS）的创建和初步测试。这个包含13个条目的筛查器主要是根据现有量表开发的，并应用于在东南部传染病诊所接受治疗的艾滋病毒感染者。为了评估SAMISS的有效性，对那些在精神疾病症状和药物使用问题筛查中呈阳性的一部分人（n = 207）进行了《精神疾病诊断与统计手册第四版》障碍的结构化临床访谈（SCID）。与SCID相比，该筛查器对精神障碍的阳性预测值为98.6%，对药物使用障碍的阳性预测值为98.6%。对于酒精依赖（kappa = 0.50，p < 0.001）、药物依赖（kappa = 0.30，p < 0.001）和药物滥用（kappa = 0.42，p < 0.001），特定筛查器症状与其相应SCID诊断之间的一致性相对较高。该筛查器在那些精神疾病症状和药物使用问题筛查呈阳性的人群中对一般精神障碍和药物使用障碍具有高度预测性，以及其简短性和易于实施的特点，使其成为检测共病症状的有用工具，以便患者能够被转介到心理健康和药物滥用专家处。该筛查器不是诊断工具，在预测特定精神疾病诊断方面价值有限。
