Department of Human Neurosciences, Sapienza University of Rome, Viale dell'Università 30, Rome 00185, Italy; Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy; International Mood & Psychotic Disorders Research Consortium, Mailman Research Center, McLean Hospital, 15 Mill Street, Belmont, MA 02478-9106, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Department of Mental Health, ASL Roma 5, Via degli Esplosivi 9, Colleferro (RM) 00034, Italy.
Psychiatry Res. 2018 Sep;267:376-381. doi: 10.1016/j.psychres.2018.06.035. Epub 2018 Jun 19.
To increase access to treatment, Italy made assessment at community mental health centers (CMHCs) independent of medical referral, resulting in increased numbers of patients to be triaged efficiently. To support this process, we evaluated SCL-90-R item-ratings to identify factors that best predicted adverse early outcomes among persons seeking first-time CMHC care in a 24-month period in Rome. A psychiatric nurse screened subjects with a brief interview and self-administered SCL-90-R and psychiatrists provided CGI ratings and ICD-9 diagnosis. Of 832 screened subjects, 32 (3.85%) were hospitalized or attempted suicide within 90 days. Six SCL-90 items (15,41,55,57,78,88) scored much higher with than without such adverse outcomes; their sum is proposed as a predictive measure ("SCL-6″). In binary multivariable logistic modeling, this factor, but not age, sex, diagnosis, or other SCL-90-derived subscales strongly predicted adverse outcomes. A ROC curve for SCL-6 reflected a strong separation between subjects with versus without adverse outcomes (AUC = 0.76). This simple screening tool may support timely identification of patients at risk of early adverse clinical outcome who require especially close follow-up.
为了增加治疗的可及性，意大利在社区心理健康中心（CMHC）进行评估时不依赖医疗转诊，从而使更多的患者能够得到高效的分诊。为了支持这一过程，我们评估了 SCL-90-R 项目评分，以确定在罗马的 24 个月期间首次寻求 CMHC 治疗的患者中，哪些因素最能预测不良早期结果。一名精神科护士通过简短的访谈和自我管理的 SCL-90-R 对受试者进行筛查，精神科医生提供 CGI 评分和 ICD-9 诊断。在 832 名接受筛查的受试者中，有 32 名（3.85%）在 90 天内住院或试图自杀。六项 SCL-90 项目（15、41、55、57、78、88）在出现此类不良结果时得分明显更高；它们的总和被提议作为一种预测指标（“SCL-6”）。在二元多变量逻辑模型中，该因素而非年龄、性别、诊断或其他 SCL-90 衍生的子量表强烈预测不良结果。SCL-6 的 ROC 曲线反映了有和没有不良结果的受试者之间的强烈分离（AUC=0.76）。这种简单的筛查工具可以支持及时识别有早期不良临床结果风险的患者，这些患者需要特别密切的随访。
