Regenstrief Institute, Inc. and the Department of Medicine, Indiana University, Indianapolis, IN 46202, USA.
Gen Hosp Psychiatry. 2010 Jul-Aug;32(4):345-59. doi: 10.1016/j.genhosppsych.2010.03.006. Epub 2010 May 7.
Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.
Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.
The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15.
The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
抑郁、焦虑和躯体化是初级保健和医学专科人群中最常见的精神障碍；每种疾病的发病率至少为 5-10%，且常相互共病。因此，人们希望有一种有效的方法来测量和监测这三种疾病。
本研究综合了两个来源的证据，即：（1）四项多中心横断面研究（其中三项在初级保健中进行，一项在妇产科实践中进行），共纳入 9740 例患者；（2）来自文献中研究这些量表的关键研究，以评估患者健康问卷（PHQ）-9 抑郁量表、广泛性焦虑障碍（GAD）-7 焦虑量表和 PHQ-15 躯体症状量表的心理计量学和实用性特征。
PHQ-9 及其简化的 8 项（PHQ-8）和 2 项（PHQ-2）版本对检测抑郁障碍具有良好的敏感性和特异性。同样，GAD-7 及其简化的 2 项（GAD-2）版本对检测广泛性焦虑、惊恐、社交焦虑和创伤后应激障碍也具有良好的操作性特征。最佳截断值为父母量表（PHQ-9 和 GAD-7）>或=10，超简版（PHQ-2 和 GAD-2）>或=3。PHQ-15 与其他评估躯体症状和筛查躯体形式障碍的简短量表相当或更优。所有三个量表的截断值为 5、10 和 15，分别代表轻度、中度和重度症状水平。PHQ-9 的变化敏感性已得到充分证实，GAD-7 和 PHQ-15 的变化敏感性也在出现但尚未明确。
PHQ-9、GAD-7 和 PHQ-15 是检测和监测抑郁、焦虑和躯体化的简短、有效性得到充分验证的工具。
