Yamashita Harue, Ariyoshi Akiyo, Uchida Hisae, Tanishima Harue, Kitamura Toshinori, Nakano Hitoo
Maternity and Perinatal Care Unit, Kyushu University Hospital, Fukuoka, Japan.
Psychiatry Clin Neurosci. 2007 Jun;61(3):226-33. doi: 10.1111/j.1440-1819.2007.01659.x.
It is believed in Japan that only psychiatrists are capable of providing reliable psychiatric diagnosis. However, more awareness of mental health issues related to perinatal care means that midwives are now required to have psychiatric diagnostic skills. The purpose of the present paper was to examine how well Japanese midwives agreed with a psychiatrist on diagnoses of different psychiatric disorders. Vignettes of 29 cases including DSM-IV mood disorders (major depressive disorder and bipolar disorder) and anxiety disorders (generalized anxiety disorder, panic disorder, phobic disorders, and obsessive-compulsive disorder) were distributed to 12 Japanese midwives. They decided the DSM-IV diagnoses independently and compared them with those made by an expert. The kappa coefficients of the diagnoses with a base rate of 0.1 or more were moderate to almost perfect (0.64-0.83). The accuracy of symptom assessment was also satisfactory. Appropriately trained Japanese midwives can use the diagnostic criteria for psychiatric disorders reliably. It is therefore feasible to dispatch midwives who are trained in psychiatric diagnosis to antenatal clinics.
在日本，人们认为只有精神科医生才有能力提供可靠的精神疾病诊断。然而，对围产期护理相关心理健康问题的更多认识意味着现在要求助产士具备精神疾病诊断技能。本文的目的是研究日本助产士与精神科医生在不同精神疾病诊断上的一致程度。将包括《精神疾病诊断与统计手册》第四版（DSM-IV）中的情绪障碍（重度抑郁症和双相情感障碍）和焦虑障碍（广泛性焦虑障碍、惊恐障碍、恐惧症和强迫症）在内的29个病例的病例摘要分发给12名日本助产士。她们独立做出DSM-IV诊断，并将其与专家做出的诊断进行比较。基础率为0.1或更高的诊断的kappa系数为中等至几乎完美（0.64 - 0.83）。症状评估的准确性也令人满意。经过适当培训的日本助产士能够可靠地使用精神疾病的诊断标准。因此，派遣经过精神疾病诊断培训的助产士到产前诊所是可行的。
