O'Neill E, McNamee R, Agius R, Gittins M, Hussey L, Turner S
Department of Occupational Health and Safety, Central Manchester and Manchester Children's University Hospitals NHS Trust, Cobbett House, Oxford Road, Manchester M139WL, UK. Elizabeth.O'
Occup Environ Med. 2008 Nov;65(11):726-31. doi: 10.1136/oem.2008.039008.
To establish the reliability and validity of work-related mental ill-health diagnoses.
A UK-based surveillance scheme for work-related ill-health involving occupational physicians (OPs) reporting suggests that mental ill-health incidence is increasing by around 13% per year, with anxiety, depression and "other work-related stress" being the most common diagnoses. There have been no studies of the validity and reliability of such diagnoses. Given the existence of a large network of psychiatrists (PSYs) also involved in surveillance of work-related ill-health, an opportunity arose to measure the concurrent validity and reliability of work-related mental ill-health diagnoses.
100 anonymised summaries of cases previously reported by OPs or PSYs were collected; each was sent to 5 PSYs and 5 OPs, who assigned a diagnosis and judged whether the case was work-related. Concurrent validity of the ill-health aspect of the diagnoses, and of the opinion as to work-relatedness, was assessed by comparing the overall classifications of cases by OPs and PSYs. Reliability of the diagnostic classification was measured by kappa matrices.
Diagnostic proportions for PSYs and OPs demonstrated good agreement for anxiety, depression, anxiety plus depression and "stress" (11%, 34%, 27%, 14%) and (14%, 30%, 27%, 17%), respectively. In both groups, kappa coefficients were high for a psychotic diagnosis (0.78, 95% CI: 0.74 to 0.83), but not as high for anxiety (0.27, 95% CI: 0.23 to 0.32), depression (0.34, 95% CI: 0.29 to 0.38) and "stress" (0.15, 95% CI: 0.10 to 0.19). The odds ratio of classifying a case as work-related among PSYs compared to OPs was 2.39 (95% CI: 1.68 to 3.38), p<0.001.
The overall agreement between OPs and PSYs on mental ill-health diagnoses suggests that OP diagnoses are valid for epidemiological purposes. However, the within-group reliability of the diagnosis "stress" is low. Given differences in judgements about work-relatedness, further research is needed to investigate this aspect of a diagnosis.
确定与工作相关的精神健康不良诊断的可靠性和有效性。
一项基于英国的与工作相关的健康不良监测计划，涉及职业医生（OPs）报告，结果显示精神健康不良发病率每年约增长13%，焦虑、抑郁和“其他与工作相关的压力”是最常见的诊断。此前尚无关于此类诊断的有效性和可靠性的研究。鉴于存在一个庞大的精神科医生（PSYs）网络也参与了与工作相关的健康不良监测，因此有机会衡量与工作相关的精神健康不良诊断的同时效度和可靠性。
收集了100份由职业医生或精神科医生先前报告的病例匿名摘要；每份摘要分别发送给5名精神科医生和5名职业医生，他们给出诊断并判断该病例是否与工作相关。通过比较职业医生和精神科医生对病例的总体分类，评估诊断中健康不良方面以及与工作相关性意见的同时效度。诊断分类的可靠性通过kappa矩阵进行测量。
精神科医生和职业医生在焦虑、抑郁、焦虑加抑郁和“压力”方面的诊断比例分别显示出良好的一致性，分别为（11%、34%、27%、14%）和（14%、30%、27%、17%）。在两组中，精神病诊断的kappa系数较高（0.78，95%置信区间：0.74至0.83），但焦虑（0.27，95%置信区间：0.23至0.32）、抑郁（0.34，95%置信区间：0.29至0.38）和“压力”（0.15，95%置信区间：0.10至0.19）的kappa系数则没那么高。与职业医生相比，精神科医生将病例分类为与工作相关的优势比为2.39（95%置信区间：1.68至3.38），p<0.001。
职业医生和精神科医生在精神健康不良诊断方面的总体一致性表明，职业医生的诊断在流行病学目的上是有效的。然而，“压力”诊断在组内的可靠性较低。鉴于在与工作相关性判断上存在差异，需要进一步研究调查诊断的这一方面。
