Rask Charlotte Ulrikka, Christensen Mogens Fjord, Borg Carsten, Søndergaard Charlotte, Thomsen Per Hove, Fink Per
Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus C, Denmark.
J Psychosom Res. 2009 May;66(5):455-64. doi: 10.1016/j.jpsychores.2008.10.012. Epub 2009 Jan 17.
Medically unexplained or functional somatic symptoms (FSS) in children constitute a major clinical problem. Epidemiological studies of this phenomenon are, however, hampered by a lack of good standardized measures. The objective of this study was therefore to (1) develop a parent-report measure of FSS in children aged 5-10 years and (2) perform an initial validation.
A parent interview, the Soma Assessment Interview (SAI), for FSS detection in young children was developed for lay interviewers with subsequent clinical assessment. A preliminary validation was based on interview tests of the parents of 54 children with well-defined physical disease, 59 with likely functional disorder and 105 from the community. Independent measures of the somatic complaints were completed before the interview, and children from the clinical samples were also assigned independent FSS diagnoses based on medical record review.
The Kappa value for two clinical assessors' agreement on FSS recognition was 0.86. Good discrimination was obtained between a community sample and a clinical sample with an expected high prevalence of FSS. In the former convergent validity with independent measures of somatic complaints was found. In the latter substantial agreement (89%) appeared between a medical record diagnosis of FSS and SAI detection of FSS.
The SAI offers comprehensive description of FSS in young children in population-based studies and may also prove useful in clinical settings. It is readily accepted and relatively quickly completed, and preliminary assessment of its validity is promising.
儿童医学上无法解释的或功能性躯体症状(FSS)是一个主要的临床问题。然而,由于缺乏良好的标准化测量方法,对这一现象的流行病学研究受到了阻碍。因此,本研究的目的是:(1)开发一种针对5至10岁儿童FSS的家长报告测量方法;(2)进行初步验证。
为非专业访谈者开发了一种用于检测幼儿FSS的家长访谈,即躯体评估访谈(SAI),随后进行临床评估。初步验证基于对54名患有明确躯体疾病儿童的家长、59名可能患有功能性障碍儿童的家长以及105名社区儿童家长的访谈测试。在访谈前完成了对躯体主诉的独立测量,并且根据病历审查为临床样本中的儿童也指定了独立的FSS诊断。
两名临床评估者在FSS识别上的一致性Kappa值为0.86。在社区样本和预期FSS患病率较高的临床样本之间获得了良好的区分度。在前者中发现与躯体主诉的独立测量具有收敛效度。在后者中,FSS的病历诊断与SAI对FSS的检测之间出现了高度一致性(89%)。
SAI在基于人群的研究中提供了对幼儿FSS的全面描述,在临床环境中可能也很有用。它很容易被接受且完成速度相对较快,对其效度的初步评估很有前景。