Baker Anna M, Holbrook Janet T, Yohannes Abebaw M, Eakin Michelle N, Sugar Elizabeth A, Henderson Robert J, Casper Anne S, Kaminsky David A, Rea Alexis L, Mathews Anne M, Que Loretta G, Ramsdell Joe W, Gerald Lynn B, Wise Robert A, Hanania Nicola A
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Ann Am Thorac Soc. 2018 Aug;15(8):926-934. doi: 10.1513/AnnalsATS.201708-631OC.
Anxiety is a common comorbidity of chronic obstructive pulmonary disease (COPD) that is associated with higher morbidity and mortality. We evaluated three anxiety screening questionnaires: the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and the Anxiety Inventory for Respiratory Disease (AIR). To evaluate and compare the test performance characteristics of three anxiety screening questionnaires, using the Mini-International Neuropsychiatric Interview (MINI), version 7.0, as the "gold standard." Individuals with COPD were recruited at 16 centers. The MINI and questionnaires were administered by trained research coordinators at an in-person visit and readministered by telephone 2-4 weeks later. A composite score for the presence of any , (DSM-V) anxiety disorder was computed, based on the MINI as the gold standard, compared with a participant screening positive on self-report measures for these analyses. Two hundred and twenty eligible individuals with COPD were enrolled; 219 completed the study. Eleven percent were identified as having a DSM-V anxiety disorder, based on the MINI. Elevated anxiety symptoms based on questionnaires were 38% for the AIR, 30% for the GAD-7, and 20% for the HADS-A. Area under the receiver operating characteristic curve (AUC) was highest for the GAD-7 (0.78; 95% confidence interval [CI], 0.69-0.87), followed by the HADS-A (0.74; 95% CI, 0.64-0.84) and the AIR (0.66; 95% CI, 0.56-0.76). The AUC for the GAD-7 was significantly greater than for the AIR ( = 0.014). Sensitivity was not statistically different among the questionnaires: 77% for the GAD-7, 63% for the HADS-A, and 66% for the AIR. The HADS-A had the highest specificity, 85%, which was significantly higher than that of the GAD-7 (77%; < 0.001) and the AIR (65%; < 0.001); GAD-7 specificity was higher than AIR specificity ( < 0.001). Symptoms of anxiety among patients with COPD as identified by screening questionnaires were common and significantly higher than the prevalence of anxiety disorder meeting DSM-V criteria. The GAD-7, the HADS-A and the AIR questionnaires had fair to moderate psychometric properties as screening tools for anxiety in individuals with COPD, indicating the need for improved measures for this patient population.
焦虑是慢性阻塞性肺疾病（COPD）常见的共病，与更高的发病率和死亡率相关。我们评估了三种焦虑筛查问卷：广泛性焦虑障碍7项量表（GAD - 7）、医院焦虑抑郁量表焦虑分量表（HADS - A）和呼吸系统疾病焦虑量表（AIR）。为了评估和比较这三种焦虑筛查问卷的测试性能特征，使用第7.0版的迷你国际神经精神访谈（MINI）作为“金标准”。在16个中心招募了慢性阻塞性肺疾病患者。MINI和问卷由经过培训的研究协调员在面对面访视时进行发放，并在2 - 4周后通过电话再次发放。基于MINI作为金标准，计算出存在任何一种（《精神疾病诊断与统计手册》第五版）焦虑症的综合得分，并与在这些分析中自我报告测量筛查呈阳性的参与者进行比较。招募了220名符合条件的慢性阻塞性肺疾病患者；219名完成了研究。根据MINI，11%的患者被确定患有《精神疾病诊断与统计手册》第五版焦虑症。基于问卷的焦虑症状升高情况，AIR为38%，GAD - 7为30%，HADS - A为20%。GAD - 7的受试者工作特征曲线下面积（AUC）最高（0.78；95%置信区间[CI]，0.69 - 0.87），其次是HADS - A（0.74；95%CI，0.64 - 0.84）和AIR（0.66；95%CI，0.56 - 0.76）。GAD - 7的AUC显著大于AIR的AUC（P = 0.014）。各问卷之间的敏感性无统计学差异：GAD - 7为77%，HADS - A为63%，AIR为66%。HADS - A具有最高的特异性，为85%，显著高于GAD - 7（77%；P < 0.001）和AIR（65%；P < 0.001）；GAD - 7的特异性高于AIR的特异性（P < 0.001）。通过筛查问卷确定的慢性阻塞性肺疾病患者中的焦虑症状很常见，且显著高于符合《精神疾病诊断与统计手册》第五版标准的焦虑症患病率。GAD - 7、HADS - A和AIR问卷作为慢性阻塞性肺疾病患者焦虑筛查工具的心理测量特性为中等至良好，表明需要针对该患者群体改进测量方法。
