Bakker Ingrid M, Terluin Berend, van Marwijk Harm W J, van Mechelen Willem, Stalman Wim A B
EMGO Institute, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands.
Eur J Public Health. 2009 Jun;19(3):303-7. doi: 10.1093/eurpub/ckn149. Epub 2009 Jan 30.
The primary care evaluation of mental disorders (PRIME-MD) can be seen as characteristic for successive refinements of criteria and structured interview techniques for diagnosing psychiatric disorders in primary care. It is one of the most widely used instruments, but there is no evidence to support its test-retest reliability.
With 1-week intervals between interviews, a test-retest study of the PRIME-MD was conducted in a general practice population of 100 distressed patients (20- to 60-years old) who were on sick leave.
Almost everyone (89%) received one or more diagnoses at both measurements, and there was fair total agreement (kappa = 0.27). The best agreement was found for more severe threshold disorders [major depressive disorder (kappa = 0.58), dysthymia (kappa = 0.57), and generalized anxiety disorder (kappa = 0.59)], while we found indefinite results for the sub-threshold disorders [anxiety disorder not otherwise specified (NOS) (kappa =.30), minor depressive disorder (kappa = -0.03), and somatoform disorder NOS (kappa = 0.11)].
The PRIME-MD is one of the few instruments in primary care that actually diagnoses specific mental disorders according to the DSM criteria. However, there was a failure to adequately classify sub-threshold disorders. Mental disorders, as seen in primary care, encompass important specific symptoms and clinical syndromes that vary in duration and severity over time, but they also encompass an admixture of somatic and psychological symptoms that do not match current diagnostic systems. This most likely resulted in methodological uncertainty about the level of agreement. Diagnostic criteria in psychiatry need to be operationalized for use in primary care and require further evaluation.
初级保健中精神障碍评估（PRIME-MD）可被视为初级保健中诊断精神障碍的标准及结构化访谈技术不断完善的一个特征。它是使用最广泛的工具之一，但尚无证据支持其重测信度。
对100名处于病假的（20至60岁）痛苦患者的普通门诊人群进行了PRIME-MD的重测研究，两次访谈间隔1周。
几乎所有人（89%）在两次测量中都得到了一个或多个诊断，总体一致性尚可（kappa = 0.27）。对于更严重的阈上障碍[重度抑郁症（kappa = 0.58）、恶劣心境（kappa = 0.57）和广泛性焦虑障碍（kappa = 0.59）]，一致性最佳，而对于阈下障碍[未另行规定的焦虑障碍（NOS）（kappa = 0.30）、轻度抑郁症（kappa = -0.03）和未另行规定的躯体形式障碍（kappa = 0.11）]，结果不明确。
PRIME-MD是初级保健中少数几种能根据《精神疾病诊断与统计手册》标准实际诊断特定精神障碍的工具之一。然而，对阈下障碍的分类不够充分。在初级保健中所见的精神障碍包括重要的特定症状和临床综合征，这些症状和综合征随时间在持续时间和严重程度上有所不同，但也包括躯体和心理症状的混合，这与当前的诊断系统不匹配。这很可能导致了一致性水平的方法学不确定性。精神病学诊断标准需要在初级保健中实施并需要进一步评估。
