VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center.
Department of Medicine, Indiana University School of Medicine.
Med Care. 2019 Nov;57(11):890-897. doi: 10.1097/MLR.0000000000001185.
Anxiety is one of the most prevalent mental disorders and accounts for substantial disability as well as increased health care costs. This study examines the minimally important difference (MID) and responsiveness of 6 commonly used anxiety scales.
The sample comprised 294 patients from 6 primary care clinics in a single VA medical center who were enrolled in a telecare trial for treatment of chronic musculoskeletal pain and comorbid depression and/or anxiety. The measures assessed were the Patient Reported Outcomes Measurement Information System (PROMIS) 4-item, 6-item, and 8-item anxiety scales; the Generalized Anxiety Disorder 7-item scale (GAD-7); the Symptom Checklist anxiety subscale (SCL); the Posttraumatic Stress Disorder Checklist (PCL); the Short Form (SF)-36 Mental Health subscale; and the SF-12 Mental Component Summary (MCS). Validity was assessed with correlations of these measures with one another and with measures of quality of life and disability. MID was estimated by triangulating several methods. Responsiveness was evaluated by comparing: (a) the standardized response means for patients who reported their mood as being better, the same, or worse at 3 months; (b) the area under the curve for patients who had improved (better) versus those who had not (same/worse).
Convergent and construct validity was supported by strong correlations of the anxiety measures with one another and moderate correlations with quality of life and disability measures, respectively. All measures differentiated patients who reported global improvement at 3 months from those who were unchanged, but were less able to distinguish worsening from no change. The area under the curves showed comparable responsiveness of the scales. The estimated MID was 4 for the PROMIS scales; 3 for the GAD-7; 6 for the PCL; 9 for the SF-36 mental health subscale; 5 for the MCS score, and 0.3 for the SCL anxiety scale.
Six commonly used anxiety scales demonstrate similar responsiveness, and estimated MIDs can be used to gauge anxiety change in clinical research and practice.
焦虑是最常见的精神障碍之一，会导致严重残疾和增加医疗保健费用。本研究考察了六种常用焦虑量表的最小重要差异（MID）和反应性。
该样本包括来自单一退伍军人事务医疗中心的 6 个初级保健诊所的 294 名患者，他们参加了一项远程治疗慢性肌肉骨骼疼痛和共病抑郁和/或焦虑的试验。评估的措施包括患者报告的结果测量信息系统（PROMIS）的 4 项、6 项和 8 项焦虑量表；广泛性焦虑障碍 7 项量表（GAD-7）；症状检查表焦虑子量表（SCL）；创伤后应激障碍检查表（PCL）；简短形式（SF）-36 心理健康子量表；以及 SF-12 心理健康成分综合评分（MCS）。通过这些措施与其他措施以及生活质量和残疾措施的相关性来评估有效性。MID 通过几种方法的三角测量来估计。通过比较：（a）报告情绪在 3 个月时变好、相同或变差的患者的标准化反应均值；（b）改善（变好）患者与未改善（相同/变差）患者的曲线下面积，来评估反应性。
通过焦虑措施之间的强相关性和与生活质量和残疾措施之间的中度相关性，支持了收敛和结构有效性。所有措施都可以区分报告 3 个月时整体改善的患者与没有变化的患者，但在区分恶化与无变化方面的能力较差。曲线下面积显示出这些量表具有相当的反应性。估计的 MID 为 PROMIS 量表的 4；GAD-7 的 3；PCL 的 6；SF-36 心理健康子量表的 9；MCS 评分的 5；以及 SCL 焦虑量表的 0.3。
六种常用的焦虑量表具有相似的反应性，估计的 MID 可用于衡量临床研究和实践中的焦虑变化。
