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2001 年 9 月 11 日以来曾服役的美国退伍军人中,初级保健 PTSD 筛查的临床实用性。

Clinical utility of the Primary Care--PTSD Screen among U.S. veterans who served since September 11, 2001.

机构信息

VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA.

出版信息

Psychiatry Res. 2010 Jul 30;178(2):330-5. doi: 10.1016/j.psychres.2009.11.009. Epub 2010 May 21.

DOI:10.1016/j.psychres.2009.11.009
PMID:20483463
Abstract

Posttraumatic stress disorder (PTSD) is a prevalent anxiety disorder that is often undetected among primary care patients. The Department of Veterans Affairs has implemented the Primary Care-PTSD Screen (PC-PTSD) to screen for PTSD; however, minimal research has examined its utility. This study was designed to assess the diagnostic accuracy of the PC-PTSD among veterans who had served since 9/11/2001, including operations in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom). Signal detection analyses were used to evaluate the performance of the PC-PTSD and two other screens, the Davidson Trauma Scale (DTS) and the SPAN, in a sample of 220 veterans with military service since 9/11/2001. The reference standard for PTSD was Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnosis based upon structured clinical interview. The impact of demographic variables on test performance was examined. A cutting score of 3 on the PC-PTSD maximized efficiency (85%; sensitivity=0.83; and specificity=0.85). Although analyses supported the utility of the PC-PTSD (area under the curve (AUC)=0.875), the measure was outperformed by both the DTS (AUC=0.944) and the SPAN (AUC=0.931). Results suggest that the PC-PTSD is an acceptable screen for PTSD among veterans. Within primary care settings, the PC-PTSD may be most advantageously employed in the context of staged screening, given the measure's relative susceptibility to false positives.

摘要

创伤后应激障碍(PTSD)是一种常见的焦虑障碍,在初级保健患者中经常未被发现。退伍军人事务部已经实施了初级保健 PTSD 筛查(PC-PTSD)来筛查 PTSD;然而,很少有研究检查其效用。本研究旨在评估 PC-PTSD 在自 2001 年 9 月 11 日以来服役的退伍军人中的诊断准确性,包括在阿富汗(持久自由行动)和伊拉克(伊拉克自由行动)的行动。使用信号检测分析来评估 PC-PTSD 以及另外两个筛查工具,即戴维森创伤量表(DTS)和 SPAN,在 220 名自 2001 年 9 月 11 日以来有军事服务的退伍军人样本中的表现。PTSD 的参考标准是基于结构临床访谈的《精神障碍诊断与统计手册》第四版(DSM-IV)诊断。检查了人口统计学变量对测试性能的影响。PC-PTSD 的 3 分切割分数最大限度地提高了效率(85%;敏感性=0.83;特异性=0.85)。尽管分析支持了 PC-PTSD 的效用(曲线下面积(AUC)=0.875),但该测量值优于 DTS(AUC=0.944)和 SPAN(AUC=0.931)。结果表明,PC-PTSD 是退伍军人 PTSD 的一种可接受的筛查方法。在初级保健环境中,鉴于该测量值容易出现假阳性,PC-PTSD 可能最有利于在分阶段筛查的背景下使用。

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