Krespi Boothby Margörit Rita, Hill Jonathan, Holcombe Christopher, Clark Louise, Fisher Jean, Salmon Peter
Istanbul Bilim Universitesi, Istanbul.
Turk Psikiyatri Derg. 2010 Spring;21(1):49-59.
Psychological problems should be identified in breast cancer patients proactively if doctors and nurses are to help them cope with the challenges imposed by their illness. Screening is one possible way to identify emotional problems proactively. Self-report questionnaires can be useful alternatives to carrying out psychiatric interviews during screening, because interviewing a large number of patients can be impractical due to limited resources. Two such measures are the Hospital Anxiety and Depression Scale (HADS) and the General Health Questionnaire-12 (GHQ-12).
The present study aimed to compare the performance of the GHQ-12, and the HADS Unitary Scale and its subscales to that of the Schedule for Affective Disorders and Schizophrenia (SADS) in identifying patients with affective disorders, including DSM major depression and generalized anxiety disorder. The sample consisted of 296 female breast cancer patients who underwent surgery for breast cancer a year previously.
A small number of patients (11%) were identified as having DSM major depression or generalized anxiety disorder based on SADS score. The findings indicate that the optimal thresholds in detecting generalized anxiety disorder and DSM major depression with the HADS anxiety and depression subscales were > or = 8 and > or = 7, with 93.3% and 77.3% sensitivity, respectively, and 77.9% and 87.1% specificity, respectively. They also had a 21% and 36% positive predictive value, respectively. Using the HADS Unitary Scale the optimal threshold for detecting affective disorders was > or = 12, with 88.9% sensitivity, 80.7% specificity, and a 35% positive predictive value. In detecting affective disorders, the optimal threshold on the GHQ-12 was > or = 2, with 77.8% sensitivity and 70.2% specificity. This scale also had a 24% positive predictive value. In detecting generalized anxiety disorder and DSM major depression, the optimal thresholds on the GHQ-12 were > or = 2 and > or = 4 with 73.3% and 77.3% sensitivity, respectively, and 67.5% and 82% specificity, respectively. The scale also had 12% and 29% positive predictive values, respectively.
The HADS Unitary Scale and its subscales were effective in identifying affective disorders. They can be used as screening measures in breast cancer patients. The GHQ-12 was less accurate in detecting affective disorders than the HADS, but it can also be used as a screening instrument to detect affective disorders, generalized anxiety disorder, and DSM major depression.
如果医生和护士想要帮助乳腺癌患者应对疾病带来的挑战，就应该主动识别他们的心理问题。筛查是主动识别情绪问题的一种可能方式。在筛查过程中，自我报告问卷可以作为进行精神科访谈的有用替代方法，因为由于资源有限，对大量患者进行访谈可能不切实际。医院焦虑抑郁量表（HADS）和一般健康问卷 - 12（GHQ - 12）就是这样两种测量工具。
本研究旨在比较GHQ - 12、HADS单一量表及其子量表与情感障碍和精神分裂症检查表（SADS）在识别情感障碍患者（包括DSM重度抑郁症和广泛性焦虑症）方面的表现。样本包括296名一年前接受过乳腺癌手术的女性乳腺癌患者。
根据SADS评分，少数患者（11%）被确定患有DSM重度抑郁症或广泛性焦虑症。研究结果表明，使用HADS焦虑和抑郁子量表检测广泛性焦虑症和DSM重度抑郁症的最佳阈值分别为≥8和≥7，敏感性分别为93.3%和77.3%，特异性分别为77.9%和87.1%。它们的阳性预测值分别为21%和36%。使用HADS单一量表检测情感障碍的最佳阈值为≥12，敏感性为88.9%，特异性为80.7%，阳性预测值为35%。在检测情感障碍时，GHQ - 12的最佳阈值为≥2，敏感性为77.8%，特异性为70.2%。该量表的阳性预测值也为24%。在检测广泛性焦虑症和DSM重度抑郁症时，GHQ - 12的最佳阈值分别为≥2和≥4，敏感性分别为73.3%和77.3%，特异性分别为67.5%和82%。该量表的阳性预测值分别为12%和29%。
HADS单一量表及其子量表在识别情感障碍方面有效。它们可作为乳腺癌患者的筛查工具。GHQ - 12在检测情感障碍方面不如HADS准确，但它也可作为检测情感障碍、广泛性焦虑症和DSM重度抑郁症的筛查工具。
