Newson Jennifer J, Hunter Daniel, Thiagarajan Tara C
Sapien Labs, Arlington, VA, United States.
Front Psychiatry. 2020 Feb 27;11:76. doi: 10.3389/fpsyt.2020.00076. eCollection 2020.
Across the landscape of mental health research and diagnosis, there is a diverse range of questionnaires and interviews available for use by clinicians and researchers to determine patient treatment plans or investigate internal and external etiologies. Although individually, these tools have each been assessed for their validity and reliability, there is little research examining the consistency between them in terms of what symptoms they assess, and how they assess those symptoms. Here, we provide an analysis of 126 different questionnaires and interviews commonly used to diagnose and screen for 10 different disorder types including depression, anxiety, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), addiction, bipolar disorder, eating disorder, and schizophrenia, as well as comparator questionnaires and interviews that offer an all-in-one cross-disorder assessment of mental health. We demonstrate substantial inconsistency in the inclusion and emphasis of symptoms assessed within disorders as well as considerable symptom overlap across disorder-specific tools. Within the same disorder, similarity scores across assessment tools ranged from 29% for assessment of bipolar disorder to a maximum of 58% for OCD. Furthermore, when looking across disorders, 60% of symptoms were assessed in at least half of all disorders illustrating the extensive overlap in symptom profiles between disorder-specific assessment tools. Biases in assessment toward emotional, cognitive, physical or behavioral symptoms were also observed, further adding to the heterogeneity across assessments. Analysis of other characteristics such as the time period over which symptoms were assessed, as well as whether there was a focus toward frequency, severity or duration of symptoms also varied substantially across assessment tools. The consequence of this inconsistent and heterogeneous assessment landscape is that it hinders clinical diagnosis and treatment and frustrates understanding of the social, environmental, and biological factors that contribute to mental health symptoms and disorders. Altogether, it underscores the need for standardized assessment tools that are more disorder agnostic and span the full spectrum of mental health symptoms to aid the understanding of underlying etiologies and the discovery of new treatments for psychiatric dysfunction.
在心理健康研究和诊断领域，临床医生和研究人员可使用各种各样的问卷和访谈来确定患者的治疗方案，或探究内在和外在病因。尽管这些工具各自都经过了效度和信度评估，但很少有研究考察它们在评估哪些症状以及如何评估这些症状方面的一致性。在此，我们对126种不同的问卷和访谈进行了分析，这些问卷和访谈常用于诊断和筛查10种不同的疾病类型，包括抑郁症、焦虑症、强迫症（OCD）、创伤后应激障碍（PTSD）、注意力缺陷多动障碍（ADHD）、自闭症谱系障碍（ASD）、成瘾、双相情感障碍、饮食失调和精神分裂症，以及提供心理健康综合跨疾病评估的对照问卷和访谈。我们发现，各疾病所评估症状的纳入和重点存在显著不一致，而且特定疾病工具之间存在相当多的症状重叠。在同一疾病中，评估工具之间的相似性得分范围从双相情感障碍评估的29%到强迫症评估的最高58%。此外，在跨疾病观察时，60%的症状在至少一半的所有疾病中都有评估，这表明特定疾病评估工具之间的症状特征存在广泛重叠。还观察到对情绪、认知、身体或行为症状评估的偏差，这进一步加剧了评估的异质性。对其他特征的分析，如评估症状的时间段，以及是否关注症状的频率、严重程度或持续时间，在评估工具之间也有很大差异。这种不一致和异质性的评估情况导致的结果是，它阻碍了临床诊断和治疗，并妨碍了对导致心理健康症状和疾病的社会、环境和生物因素的理解。总体而言，这凸显了对标准化评估工具的需求，这些工具应更不依赖于特定疾病，并涵盖心理健康症状的全谱，以帮助理解潜在病因并发现针对精神功能障碍的新治疗方法。
