Applied Health Sciences (Mental Health), University of Aberdeen, Royal Cornhill Hospital, Aberdeen, UK.
Br J Gen Pract. 2011 Jul;61(588):e419-26. doi: 10.3399/bjgp11X583209.
The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose.
To assess the discriminatory performance of the QOF depression severity measures.
Psychometric assessment in nine Scottish general practices.
Adult primary care patients diagnosed with depression were invited to participate. The HADS-D, PHQ-9, and BDI-II were assessed against the HRSD-17 interview. Discriminatory performance was determined relative to the HRSD-17 cut-offs for symptoms of at least moderate severity, as per criteria set by the American Psychiatric Association (APA) and NICE. Receiver operating characteristic curves were plotted and area under the curve (AUC), sensitivity, specificity, and likelihood ratios (LRs) calculated.
A total of 267 were recruited per protocol, mean age = 49.8 years (standard deviation [SD] = 14.1), 70% female, mean HRSD-17=12.6 (SD = 7.62, range = 0-34). For APA criteria, AUCs were: HADS-D = 0.84; PHQ-9 = 0.90; and BDI-II = 0.86. Optimal sensitivity and specificity were reached where HADS-D ≥9 (74%, 76%); PHQ-9 ≥12 (77%, 79%), and BDI-II ≥23 (74%, 75%). For NICE criteria: HADS-D AUC = 0.89; PHQ-9 AUC = 0.93; and BDI-II AUC = 0.90. Optimal sensitivity and specificity were reached where HADS-D ≥10 (82%, 75%), PHQ-9 ≥15 (89%, 83%), and BDI-II ≥28 (83%, 80%). LRs did not provide evidence of sufficient accuracy for clinical use.
As selecting treatment according to depression severity is informed by an evidence base derived from trials using HRSD-17, and none of the measures tested aligned adequately with that tool, they are inappropriate for use.
英国质量和结果框架（QOF）奖励医生测量抑郁症患者症状严重程度的措施，但为此目的，经过认可的量表尚未得到全面验证。
评估 QOF 抑郁严重程度测量的区分性能。
在苏格兰的 9 家普通诊所进行心理测量评估。
邀请被诊断患有抑郁症的成年初级保健患者参与。评估 HADS-D、PHQ-9 和 BDI-II 与 HRSD-17 访谈的相关性。根据美国精神病学协会（APA）和 NICE 设定的标准，相对于 HRSD-17 中度以上严重程度的切点，确定区分性能。绘制受试者工作特征曲线，并计算曲线下面积（AUC）、敏感度、特异度和似然比（LR）。
根据方案共招募了 267 名患者，平均年龄为 49.8 岁（标准差 [SD] = 14.1），70%为女性，平均 HRSD-17=12.6（SD = 7.62，范围 0-34）。对于 APA 标准，AUC 为：HADS-D = 0.84；PHQ-9 = 0.90；BDI-II = 0.86。当 HADS-D≥9（74%，76%）时，灵敏度和特异度达到最佳；PHQ-9≥12（77%，79%），BDI-II≥23（74%，75%）。对于 NICE 标准：HADS-D AUC = 0.89；PHQ-9 AUC = 0.93；BDI-II AUC = 0.90。当 HADS-D≥10（82%，75%），PHQ-9≥15（89%，83%），BDI-II≥28（83%，80%）时，灵敏度和特异度达到最佳。LR 没有提供足够的准确性证据，不适合临床使用。
由于根据 HRSD-17 试验得出的证据基础来选择治疗方法，而没有一种经过测试的量表与该工具完全一致，因此它们不适合使用。
