Grech Megan, Turnbull Deborah A, Wittert Gary A, Tully Phillip J
School of Psychology, The University of Adelaide, Adelaide, SA, Australia.
Freemasons Foundation Centre for Men's Health, School of Medicine, The University of Adelaide, Adelaide, SA, Australia.
Front Psychol. 2019 Dec 17;10:2829. doi: 10.3389/fpsyg.2019.02829. eCollection 2019.
Depression and anxiety disorders are common among cardiovascular disease (CVD) populations, leading several cardiology societies to recommend routine screening to streamline psychological interventions. However, it remains poorly understood whether routine screening in CVD populations identifies the broader groups of disorders that cluster together within individuals, known as anxious-misery and fear. This study examines the screening utility of four anxiety and depression questionnaires to identify the two internalizing disorder clusters; anxious-misery and fear. Patients with a recent hospital admission for CVD ( = 85, 69.4% males) underwent a structured clinical interview with the MINI International Neuropsychiatric Interview. The participants also completed the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale, Overall Anxiety Severity Impairment Scale (OASIS), and the stress subscale of the Depression Anxiety Stress Scale (DASS). The PHQ-9 and the GAD-7 yielded appropriate screening properties to detect three different iterations of the anxious-misery cluster (sensitivity >80.95% and specificity >82.81%). The GAD-7 was the only instrument to display favorable screening properties to detect a fear cluster omitting post-traumatic stress disorder (PTSD) but including obsessive-compulsive disorder (OCD; sensitivity 81.25%, specificity 76.81%). These findings indicate that the PHQ-9 and GAD-7 could be implemented to reliably screen for anxious-misery disorders among CVD in-patients, however, the receiver operating characteristics (ROC) to detect fear disorders were contingent on the placement of PTSD and OCD within clusters. The findings are discussed in relation to routine screening guidelines in CVD populations and contemporary understandings of the internalizing disorders.
抑郁症和焦虑症在心血管疾病（CVD）人群中很常见，这使得多个心脏病学会建议进行常规筛查，以简化心理干预措施。然而，目前人们对CVD人群中的常规筛查能否识别个体中聚集在一起的更广泛的疾病组（即焦虑痛苦和恐惧）仍知之甚少。本研究考察了四种焦虑和抑郁问卷对识别两种内化性障碍组（焦虑痛苦和恐惧）的筛查效用。近期因CVD住院的患者（n = 85，69.4%为男性）接受了采用MINI国际神经精神访谈的结构化临床访谈。参与者还完成了患者健康问卷（PHQ - 9）、广泛性焦虑障碍（GAD - 7）量表、总体焦虑严重程度损害量表（OASIS）以及抑郁焦虑压力量表（DASS）的压力分量表。PHQ - 9和GAD - 7产生了适当的筛查特性，以检测焦虑痛苦组的三种不同迭代形式（敏感性>80.95%，特异性>82.81%）。GAD - 7是唯一一种显示出良好筛查特性的工具，可检测出一个省略创伤后应激障碍（PTSD）但包括强迫症（OCD）的恐惧组（敏感性81.25%，特异性76.81%）。这些发现表明，PHQ - 9和GAD - 7可用于可靠地筛查CVD住院患者中的焦虑痛苦障碍，然而，检测恐惧障碍接收者操作特征（ROC）取决于PTSD和OCD在组内的位置。本文结合CVD人群的常规筛查指南以及对内化性障碍的当代理解对这些发现进行了讨论。
