一项针对中低收入国家焦虑障碍和创伤后应激障碍的经过验证的筛查工具的系统评价。

A systematic review of validated screening tools for anxiety disorders and PTSD in low to middle income countries.

机构信息

The University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.

Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.

出版信息

BMC Psychiatry. 2020 Jun 30;20(1):338. doi: 10.1186/s12888-020-02753-3.

DOI:10.1186/s12888-020-02753-3

PMID:32605551

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7325104/

Abstract

BACKGROUND

Anxiety and post-traumatic stress disorder (PTSD) contribute significantly to disability adjusted life years in low- to middle-income countries (LMICs). Screening has been proposed to improve identification and management of these disorders, but little is known about the validity of screening tools for these disorders. We conducted a systematic review of validated screening tools for detecting anxiety and PTSD in LMICs.

METHODS

MEDLINE, EMBASE, Global Health and PsychINFO were searched (inception-April 22, 2020). Eligible studies (1) screened for anxiety disorders and/or PTSD; (2) reported sensitivity and specificity for a given cut-off value; (3) were conducted in LMICs; and (4) compared screening results to diagnostic classifications based on a reference standard. Screening tool, cut-off, disorder, region, country, and clinical population were extracted for each study, and we assessed study quality. Accuracy results were organized based on screening tool, cut-off, and specific disorder. Accuracy estimates for the same cut-off for the same screening tool and disorder were combined via meta-analysis.

RESULTS

Of 6322 unique citations identified, 58 articles including 77 screening tools were included. There were 46, 19 and 12 validations for anxiety, PTSD, and combined depression and anxiety, respectively. Continentally, Asia had the most validations (35). Regionally, South Asia (11) had the most validations, followed by South Africa (10) and West Asia (9). The Kessler-10 (7) and the Generalized Anxiety Disorder-7 item scale (GAD-7) (6) were the most commonly validated tools for anxiety disorders, while the Harvard Trauma Questionnaire (3) and Posttraumatic Diagnostic Scale (3) were the most commonly validated tools for PTSD. Most studies (29) had the lowest quality rating (unblinded). Due to incomplete reporting, we could meta-analyze results from only two studies, which involved the GAD-7 (cut-off ≥10, pooled sensitivity = 76%, pooled specificity = 64%).

CONCLUSION

Use of brief screening instruments can bring much needed attention and research opportunities to various at-risk LMIC populations. However, many have been validated in inadequately designed studies, precluding any general recommendation for specific tools in LMICs. Locally validated screening tools for anxiety and PTSD need further evaluation in well-designed studies to assess whether they can improve the detection and management of these common disorders.

TRIAL REGISTRATION

PROSPERO registry number CRD42019121794 .

摘要

背景

焦虑症和创伤后应激障碍（PTSD）在中低收入国家（LMICs）显著导致伤残调整生命年。筛查被提出用于改善这些障碍的识别和管理，但对于这些障碍的筛查工具的有效性知之甚少。我们对在 LMICs 中用于检测焦虑症和 PTSD 的经过验证的筛查工具进行了系统评价。

方法

检索 MEDLINE、EMBASE、全球健康和 PsychINFO（从开始到 2020 年 4 月 22 日）。合格的研究（1）筛查焦虑障碍和/或 PTSD；（2）报告了特定切点的敏感性和特异性；（3）在 LMICs 中进行；（4）将筛查结果与基于参考标准的诊断分类进行比较。为每项研究提取筛查工具、切点、障碍、区域、国家和临床人群，并评估研究质量。根据筛查工具、切点和特定障碍对准确性结果进行组织。对于相同筛查工具和障碍的相同切点，通过荟萃分析合并准确性估计值。

结果

在 6322 条独特的引文中共确定了 58 篇文章，其中包括 77 种筛查工具。分别有 46、19 和 12 个验证用于焦虑症、PTSD 和抑郁和焦虑的综合。在大陆层面，亚洲的验证最多（35）。在区域层面，南亚（11）的验证最多，其次是南非（10）和西亚（9）。Kessler-10（7）和广泛性焦虑障碍-7 项量表（GAD-7）（6）是最常用于焦虑症的验证工具，而哈佛创伤问卷（3）和创伤后诊断量表（3）是最常用于 PTSD 的验证工具。大多数研究（29）的质量评分最低（未设盲）。由于报告不完整，我们只能对涉及 GAD-7（切点≥10，合并敏感性=76%，合并特异性=64%）的两项研究进行荟萃分析。