Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
Mult Scler Relat Disord. 2018 Feb;20:9-15. doi: 10.1016/j.msard.2017.12.007. Epub 2017 Dec 16.
We aimed to evaluate the validity and reliability of multiple screening measures for depression and anxiety for use in the clinical care of people with multiple sclerosis (MS).
Participants with MS completed the Patient Health Questionnaire (PHQ-9), Hospital Anxiety and Depression Scale (HADS), Kessler-6 Distress Scale, PROMIS Emotional Distress Depression Short-Form 8a (PROMIS Depression) and Anxiety Short-Form 8a (PROMIS Anxiety), Generalized Anxiety Disorder 7-item Scale (GAD-7), and the Overall Anxiety and Severity Impairment Scale (OASIS). A subgroup repeated the screening measures two weeks later. All participants also completed a Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID). For the screening measures we computed sensitivity, specificity, positive predictive and negative predictive value with SCID diagnoses as the reference standard and conducted receiver operating curve (ROC) analyses; we also assessed internal consistency and test-retest reliability.
Of 253 participants, the SCID classified 10.3% with major depression and 14.6% with generalized anxiety disorder. Among the depression measures, the PHQ-9 had the highest sensitivity (84%). Specificity was generally higher than sensitivity, and was highest for the HADS-D with a cut-point of 11 (95%). In ROC analyses the area under the curve (AUC) did not differ between depression measures. Among the anxiety measures, sensitivity was highest for the HADS-A with a cut-point of 8 (82%). Specificity ranged from 83% to 86% for all measures except the HADS-A with a cut-point of 8 (68%). The AUC did not differ between anxiety measures.
Overall, performance of the depression and anxiety screening measures was very similar, with reasonable psychometric properties for the MS population, suggesting that other factors such as accessibility and ease of use could guide the choice of measure in clinical practice.
我们旨在评估多种用于多发性硬化症（MS）患者临床护理的抑郁和焦虑筛查工具的有效性和可靠性。
MS 患者完成了患者健康问卷（PHQ-9）、医院焦虑抑郁量表（HADS）、Kessler-6 痛苦量表、PROMIS 情绪困扰抑郁短式 8a 量表（PROMIS 抑郁）和焦虑短式 8a 量表（PROMIS 焦虑）、广泛性焦虑障碍 7 项量表（GAD-7）和总体焦虑严重程度损伤量表（OASIS）。一个亚组在两周后重复进行了筛查测试。所有参与者还完成了 DSM-IV-TR 轴 I 障碍的结构临床访谈（SCID）。对于筛查工具，我们使用 SCID 诊断作为参考标准，计算了灵敏度、特异性、阳性预测值和阴性预测值，并进行了接收者操作曲线（ROC）分析；我们还评估了内部一致性和测试-重测信度。
在 253 名参与者中，SCID 将 10.3%的人诊断为重度抑郁症，14.6%的人诊断为广泛性焦虑障碍。在抑郁测量中，PHQ-9 的灵敏度最高（84%）。特异性通常高于灵敏度，HADS-D 的截断值为 11 时特异性最高（95%）。在 ROC 分析中，抑郁测量的曲线下面积（AUC）没有差异。在焦虑测量中，HADS-A 的截断值为 8 时灵敏度最高（82%）。除了 HADS-A 的截断值为 8 时（68%），所有测量的特异性都在 83%到 86%之间。焦虑测量的 AUC 没有差异。
总体而言，抑郁和焦虑筛查工具的性能非常相似，对 MS 人群具有合理的心理测量学特性，这表明其他因素，如可及性和易用性，可能会指导在临床实践中选择测量工具。
