School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Department of Psychiatry, McGill University and Douglas Mental Health University Institute Research Centre, Montreal, Quebec, Canada.
Int J Methods Psychiatr Res. 2018 Mar;27(1). doi: 10.1002/mpr.1601. Epub 2017 Dec 28.
There is an increasing debate about the impact of mental health screening. We illustrate the use of a decision making framework that can be applied when there is no sufficient data to support a traditional cost-benefit analysis.
We conducted secondary analyses of data from 459 male prisoners who were screened upon intake. We compared the potential benefit of different approaches (screening, history taking, and universal interventions) to allocating treatment resources using decision curve analysis.
Screening prisoners for distress at typical levels of sensitivity (75%) and specificity (71%) were estimated to provide the greatest net benefit if between 2 and 5 false positives per detected illness are tolerable. History taking and self-harm screening provide the largest net benefit when only 1 or 2 false positives per detected illness would be tolerable. The benefits of screening were less among those without a recent psychiatric history, ethnic minorities, and those with fewer psychosocial needs.
Although screening has potential to increase detection of treatment, important subgroup differences exist. Greater consideration of responses to positive screens or alternatives to screening are needed to maximize the impact of efforts to improve detection and treatment of mental illness.
关于心理健康筛查的影响，目前存在着越来越多的争议。我们举例说明了一种决策框架的使用方法，该方法可适用于缺乏足够数据支持传统成本效益分析的情况。
我们对 459 名入监男性囚犯的资料进行了二次分析，这些囚犯在入监时接受了筛查。我们使用决策曲线分析比较了不同方法（筛查、病史询问和普遍干预）在分配治疗资源方面的潜在收益。
如果每发现 1 例疾病可容忍 2 至 5 例假阳性，那么以典型的灵敏度（75%）和特异性（71%）对囚犯进行痛苦筛查估计可提供最大的净收益。如果每发现 1 例疾病可容忍 1 至 2 例假阳性，那么病史询问和自残筛查可提供最大的净收益。在没有近期精神病史、少数民族和心理社会需求较少的人群中，筛查的益处较小。
尽管筛查有提高治疗检出率的潜力，但存在重要的亚组差异。需要更多地考虑对阳性筛查结果的反应或筛查的替代方法，以最大限度地提高改善精神疾病检出和治疗工作的效果。
