Dahl Alv A, Krüger Marit Bjartveit, Dahl Nils Håvard, Karlsson Hasse, Von Knorring Lars, Stordal Eystein
Department of Clinical Cancer Research, The Norwegian Radiumhospital, Rikshospitalet University Hospital, Oslo, Norway.
Nord J Psychiatry. 2009 Nov;63(6):443-53. doi: 10.3109/08039480902874769.
The diagnostic ability of general practitioners (GPs) concerning mental disorders is not optimal, and could be improved by structured diagnostic interviews. Various aspects of the Structured Psychiatric Interview for General Practice (SPIFA) are examined.
The inter-rater reliability of the SPIFA, the time used by GPs and specialists and the GPs satisfaction are examined. The properties of the SPIFA are compared with those of the Prime-MD and the MINI schedules.
Inter-rater reliability of the SPIFA was tested in 336 patients in general practice. The patients were randomized to two interview strategies. Either both GPs and psychiatrists used the SPIFA, or GPs used the SPIFA and psychiatrists a modified version of the SCID for Axis I disorders. The satisfaction was investigated by a questionnaire sent to 1000 GPs who had SPIFA training.
The SPIFA showed adequate inter-rater reliability for depression, anxiety disorders and increased suicidal risk for both interview strategies. In patients with more than two co-morbid disorders, the inter-rater reliability was poor. The mean duration of SPIFA was 21 min for SPIFA screening and 22 min for SPIFA manual. The 192 GPs responding to the questionnaire were mostly satisfied with the SPIFA.
The SPIFA seems to be a reliable, valid and helpful instrument for GPs making diagnoses of mental disorders in their patients. Compared with the Prime MD and the MINI, the SPIFA seemed to have comparable psychometric properties but better feasibility in primary care.
全科医生（GP）对精神障碍的诊断能力并不理想，而结构化诊断访谈可能会改善这一情况。本文对全科医疗结构化精神科访谈（SPIFA）的各个方面进行了研究。
研究SPIFA的评分者间信度、全科医生和专科医生使用该访谈的时间以及全科医生的满意度。将SPIFA的特性与简明国际神经精神访谈（Prime-MD）和迷你国际神经精神病学访谈（MINI）进行比较。
在336名全科医疗患者中测试了SPIFA的评分者间信度。患者被随机分配到两种访谈策略中。要么全科医生和精神科医生都使用SPIFA，要么全科医生使用SPIFA，而精神科医生使用针对轴I障碍的SCID修改版。通过向1000名接受过SPIFA培训的全科医生发送问卷来调查满意度。
对于两种访谈策略，SPIFA在抑郁症、焦虑症以及自杀风险增加方面均显示出足够的评分者间信度。在患有两种以上共病的患者中，评分者间信度较差。SPIFA筛查的平均时长为21分钟，使用手册进行访谈的平均时长为22分钟。回复问卷的192名全科医生大多对SPIFA感到满意。
SPIFA似乎是一种可靠、有效且有助于全科医生对患者进行精神障碍诊断的工具。与Prime MD和MINI相比，SPIFA似乎具有相当的心理测量特性，但在初级保健中的可行性更好。
