Ross H E, Glaser F B
Department of Psychiatry, Addiction Research Foundation, Toronto, Ontario, Canada.
Am J Drug Alcohol Abuse. 1989;15(4):429-42. doi: 10.3109/00952998908992802.
The 60-item General Health Questionnaire (GHQ) and the National Institute of Mental Health Diagnostic Interview Schedule (DIS) were administered to 501 patients presenting for assessment or treatment of alcohol or drug problems at the Addiction Research Foundation, Toronto, Canada. The GHQ proved to be a useful, if limited, instrument for routine screening for psychiatric disorders other than substance abuse in this population. The sensitivity or "utility" of the test at the optimum threshold score was considerably lower in this sample than in medical or community samples. Receiver Operating Characteristic (ROC) analysis suggests a need for an upward revision of the cut-off score to 23/24 inpatients with alcohol or drug problems. At this threshold, sensitivity was 69%, specificity 75%, positive predictive value 77%, negative predictive value 66%, and overall misclassification rate 29%. A definition of "caseness" was used that included all DIS Axis I disorders with the exception of substance use and "cognitive impairment." Sensitivity of the GHQ was highest for the affective disorders (79%). False negatives accounted for the bulk (61%) of the misclassification rate. At the threshold score of 23/24, positive predictive values were greater for the unemployed and for patients with either no current substance use disorder or with both alcohol and drug disorders.
对在加拿大多伦多成瘾研究基金会接受酒精或药物问题评估或治疗的501名患者进行了60项一般健康问卷（GHQ）和美国国立精神卫生研究所诊断访谈表（DIS）调查。结果证明，GHQ对于该人群中除药物滥用之外的精神疾病常规筛查来说，即便作用有限，但仍是一种有用的工具。在这个样本中，该测试在最佳临界值时的敏感度或“效用”比在医学样本或社区样本中要低得多。受试者工作特征（ROC）分析表明，对于有酒精或药物问题的住院患者，需要将临界值分数上调至23/24。在此临界值时，敏感度为69%，特异度为75%，阳性预测值为77%，阴性预测值为66%，总体错误分类率为29%。所采用的“病例”定义包括所有除药物使用和“认知障碍”之外的DIS轴I障碍。GHQ对情感障碍的敏感度最高（79%）。错误分类率中大部分（61%）为假阴性。在临界值分数23/24时，失业者以及当前既无药物使用障碍，或同时患有酒精和药物障碍的患者的阳性预测值更高。
