Konstantakopoulos G, Sofianopoulou E, Touloumi G, Ploumpidis D
Community Mental Health Center Byron-Kaisariani, 1st Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece.
Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
Psychiatriki. 2013 Oct-Dec;24(4):288-97.
Depression and anxiety disorders are the two most common mental health problems seen in the primary care and the general hospital settings. They are both associated with poorer patient functioning, worse quality of life, more frequent utilization of health services, and higher health care costs. However, detection rates of depression and anxiety by non-mental health specialists remain very low, while most of the proposed screening tools are rather not practical and therefore they have not been widely used in practice. Over the last two decades, ultra-short tools including one to three questions have been developed and suggested as case-finding methods and their sensitivity and specificity have been investigated. We reviewed all the ultra-short screening tools for depression and anxiety and the existing evidence on their accuracy in detecting major depression and anxiety disorders. Two simple screening questions for depression, about depressed mood and loss of interest or pleasure in doing things, have been repeatedly applied in primary care settings and found to have satisfactory sensitivity but low specificity. The addition of a third question inquiring if help is needed to the two screening questions for depression improves the specificity, however on the cost of reducing the sensitivity of the method. Screening for depression using only one of these questions alone was found to be less accurate strategy than the two or three question tests. The Patient Health Questionnaire-2 (PHQ-2) includes the same two depression-questions with rating scale answer choices and it was found to be more accurate than the two question test with dichotomous (yes or no) answers. Ultra-short screening strategies for depression in older people were found to have acceptable levels of accuracy, while in patients with cancer the two question tests had higher sensitivity and specificity than in other patient groups. According to the existing data, the Generalized Anxiety Disorder-2 (GAD-2) questionnaire, which includes two questions on "feeling nervous, anxious or on edge" and "not being able to stop or control worrying" appears to have acceptable accuracy in identifying clinically significant anxiety. We concluded that there is sufficient evidence on the suitability of the ultra-short screening instruments for depression and anxiety -especially the PHQ-2, the GAD-2 and their combination, the PHQ-4- for use in epidemiological studies. In primary and secondary care settings, the ultra-short tools can be used only as an initial screening method but diagnosis made by specially-trained clinicians or mental health specialists is warranted for patients who initially screen positive.
抑郁症和焦虑症是在初级保健和综合医院环境中最常见的两种心理健康问题。它们都与患者功能较差、生活质量较低、更频繁地使用医疗服务以及更高的医疗成本相关。然而，非心理健康专家对抑郁症和焦虑症的检出率仍然很低，而大多数推荐的筛查工具并不实用，因此它们尚未在实践中广泛使用。在过去二十年中，已经开发出包括一至三个问题的超短工具，并建议将其作为病例发现方法，且对其敏感性和特异性进行了研究。我们回顾了所有用于抑郁症和焦虑症的超短筛查工具以及它们在检测重度抑郁症和焦虑症方面准确性的现有证据。两个关于抑郁症的简单筛查问题，即关于情绪低落以及对做事失去兴趣或愉悦感，已在初级保健环境中反复应用，发现其具有令人满意的敏感性，但特异性较低。在这两个抑郁症筛查问题中增加一个询问是否需要帮助的第三个问题可提高特异性，但代价是降低了该方法的敏感性。仅使用这些问题中的一个进行抑郁症筛查被发现是一种比两个或三个问题测试准确性更低的策略。患者健康问卷 -2（PHQ-2）包含相同的两个抑郁症问题以及评分量表答案选项，并且发现它比具有二分法（是或否）答案的两个问题测试更准确。在老年人中，抑郁症的超短筛查策略被发现具有可接受的准确性水平，而在癌症患者中，两个问题测试的敏感性和特异性高于其他患者群体。根据现有数据，广泛性焦虑症问卷 -2（GAD-2），其中包括关于“感到紧张、焦虑或烦躁不安”和“无法停止或控制担忧”的两个问题，在识别具有临床意义的焦虑方面似乎具有可接受的准确性。我们得出结论，有充分证据表明超短筛查工具适用于抑郁症和焦虑症——特别是 PHQ-2、GAD-2 及其组合 PHQ-4——可用于流行病学研究。在初级和二级保健环境中，超短工具仅可作为初始筛查方法使用，但对于最初筛查呈阳性的患者，由经过专门培训的临床医生或心理健康专家进行诊断是必要的。
