Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada.
Arthritis Care Res (Hoboken). 2020 Aug;72(8):1130-1139. doi: 10.1002/acr.24011. Epub 2020 Jul 8.
To test the validity and reliability of screening instruments for depression and anxiety in rheumatoid arthritis (RA).
Participants with RA completed the Patient Health Questionnaire (PHQ-2 or PHQ-9), the Patient Reported Outcomes Measurement Information System depression short form 8a and anxiety short form 8a, the Hospital Anxiety and Depression Scale anxiety score (HADS-A) and depression score (HADS-D), the Overall Anxiety Severity and Impairment Scale, the Generalized Anxiety Disorder 2- and 7-item scales, and the Kessler-6 scale. Clinical depression and anxiety disorders were confirmed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders (SCID-1) research version. We reported sensitivity, specificity, positive predictive value, and negative predictive value using SCID-1 diagnoses as the criterion standard. Test-retest reliability was assessed with the intraclass correlation coefficient.
Of 150 participants, 11.3% had SCID-1-diagnosed depression, 7.3% had SCID-1-diagnosed generalized anxiety disorder, and 19.3% had any SCID-1-diagnosed anxiety disorder. For depression, sensitivity ranged from HADS-D (cut point 11; 35%) to PHQ-2 (88%) and PHQ-9 (87%). Specificity ranged from PHQ-9 (77%) and PHQ-2 (84%) to HADS-D (cut point 11; 94%). Positive predictive value ranged from 30% to 43%. Negative predictive value ranged from 92% to 98%. For generalized anxiety disorder, sensitivity ranged from HADS-A (cut point 11; 45%) to HADS-A (cut point 8; 91%). Specificity ranged from 81% to 89% for all measures except the HADS-A (cut point 8; 63%). Intraclass correlation coefficient estimates ranging from 0.69 to 0.88 confirmed good test-retest reliability.
Depression screening instruments had good diagnostic performance; anxiety instruments were more variable. Identified depression and anxiety require clinical confirmation.
测试用于类风湿关节炎（RA）患者抑郁和焦虑的筛查工具的有效性和可靠性。
RA 患者完成了患者健康问卷（PHQ-2 或 PHQ-9）、患者报告的结果测量信息系统抑郁 8a 短表和焦虑 8a 短表、医院焦虑抑郁量表焦虑评分（HADS-A）和抑郁评分（HADS-D）、总体焦虑严重程度和障碍量表、广泛性焦虑症 2 项和 7 项量表以及 Kessler-6 量表。使用精神障碍诊断与统计手册第四版轴 I 障碍的结构临床访谈（SCID-1）研究版确认临床抑郁症和焦虑症。我们使用 SCID-1 诊断作为标准，报告了灵敏度、特异性、阳性预测值和阴性预测值。使用组内相关系数评估了重测信度。
在 150 名参与者中，11.3%的人被 SCID-1 诊断为抑郁症，7.3%的人被 SCID-1 诊断为广泛性焦虑症，19.3%的人被 SCID-1 诊断为任何焦虑症。对于抑郁症，灵敏度从 HADS-D（切点 11；35%）到 PHQ-2（88%）和 PHQ-9（87%）不等。特异性从 PHQ-9（77%）和 PHQ-2（84%）到 HADS-D（切点 11；94%）不等。阳性预测值从 30%到 43%不等。阴性预测值从 92%到 98%不等。对于广泛性焦虑症，灵敏度从 HADS-A（切点 11；45%）到 HADS-A（切点 8；91%）不等。除 HADS-A（切点 8；63%）外，所有指标的特异性均在 81%至 89%之间。范围在 0.69 至 0.88 之间的组内相关系数估计值证实了良好的重测信度。
抑郁筛查工具具有良好的诊断性能；焦虑工具则更具变异性。确定的抑郁和焦虑需要临床确认。
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