From the Division of Clinical Psychology and Psychotherapy (Laferton, Stenzel), Psychologische Hochschule Berlin; Divisions of Clinical Psychology and Psychotherapy (Rief) and Clinical Biopsychology (Klaus, Mewes), Philipps University Marburg; Institute of Medical Psychology (Brähler), Medical School, University of Leipzig; and Department of Psychosomatic Medicine and Psychotherapy (Brähler), University Medical Center of the Johannes Gutenberg University Mainz, Germany.
Psychosom Med. 2017 Nov/Dec;79(9):974-981. doi: 10.1097/PSY.0000000000000530.
The new DSM-5 somatic symptom disorder was introduced to improve the diagnosis of persons experiencing what used to be called somatoform disorders. So far, it is unclear whether existing self-report measures are useful to detect the new somatic symptom disorder. This study investigates the diagnostic accuracy of three self-report questionnaires that measure somatic complaints (15 item Patient Health Questionnaire [PHQ-15]) and psychological features (7-item Whiteley Index [WI-7]; Scale for Assessing Illness Behavior [SAIB]), in detecting somatic symptom disorder.
A nationally representative general population survey was performed resulting in 250 participants (minimum age = 14 years. 12.8% participation rate). Assessment took place at baseline and 12-month follow-up. Individual and combined diagnostic accuracy of the PHQ-15, WI-7, and SAIB in detecting somatic symptom disorder was evaluated using the area under the curve (AUC) of a receiver operating characteristic.
Diagnostic accuracy was adequate to good for each individual questionnaire (PHQ-15: AUC = 0.79, p < .001, 95% confidence interval [CI] = 0.73-0.85; WI-7: AUC = 0.76, p < .001, 95% CI = 0.69-0.83; SAIB: AUC = 0.77, p < .001, 95% CI = 0.71-0.83). Combining the PHQ-15 and the WI-7 slightly improved diagnostic accuracy (AUC = 0.82, p < .001, 95% CI = 0.77-0.88), as did the combination of all three questionnaires (AUC = 0.85, p < .001, 95% CI = 0.79-0.90).
The PHQ-15, WI-7, and SAIB are useful screening instruments to detect persons at risk for somatic symptom disorder, and a combination of these three instruments slightly improves diagnostic accuracy. Their use in routine care will lead to improved detection rates.
DSM-5 中的躯体症状障碍是为了改善对以往躯体形式障碍患者的诊断而引入的。到目前为止，尚不清楚现有的自评量表是否有助于发现新的躯体症状障碍。本研究旨在探讨三种测量躯体症状（15 项患者健康问卷[PHQ-15]）和心理特征（7 项怀特利指数[WI-7]；疾病行为量表[SAIB]）的自评问卷检测躯体症状障碍的诊断准确性。
本研究进行了一项全国性的代表性人群调查，共纳入 250 名参与者（最小年龄=14 岁，参与率为 12.8%）。评估在基线和 12 个月随访时进行。使用受试者工作特征曲线下面积（AUC）评估 PHQ-15、WI-7 和 SAIB 个体和联合诊断检测躯体症状障碍的准确性。
每个单独问卷的诊断准确性均为中等至良好（PHQ-15：AUC=0.79，p<0.001，95%置信区间[CI]：0.73-0.85；WI-7：AUC=0.76，p<0.001，95%CI：0.69-0.83；SAIB：AUC=0.77，p<0.001，95%CI：0.71-0.83）。PHQ-15 和 WI-7 的联合使用略微提高了诊断准确性（AUC=0.82，p<0.001，95%CI：0.77-0.88），而三个问卷的联合使用则进一步提高了诊断准确性（AUC=0.85，p<0.001，95%CI：0.79-0.90）。
PHQ-15、WI-7 和 SAIB 是有用的筛查工具，可用于检测躯体症状障碍风险人群，且联合使用这三种工具可略微提高诊断准确性。在常规护理中使用这些工具将提高检测率。
