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儿童和青少年焦虑、抑郁、强迫症和创伤后应激障碍的国际共识:一套标准的结局测量指标。

International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder.

机构信息

Evidence Based Practice Unit, Faculty of Brain Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, London, UK.

International Consortium for Health Outcomes Measurement (ICHOM), London, UK.

出版信息

Lancet Psychiatry. 2021 Jan;8(1):76-86. doi: 10.1016/S2215-0366(20)30356-4.

Abstract

A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.

摘要

改善心理健康护理效果的一个主要障碍是缺乏对结果测量的共识。国际健康结果测量联合会 (ICHOM) 已经为成年人的焦虑和抑郁制定了基于共识的标准结果集(包括患者健康问卷-9、广泛性焦虑障碍 7 项量表和世界卫生组织残疾量表)。本立场文件报告了专门针对 6 至 24 岁儿童和青少年的焦虑、抑郁、强迫症和创伤后应激障碍的建议。一个由 27 名临床、研究和生活经验专家组成的国际 ICHOM 工作组通过电话会议、使用改编 Delphi 技术(一种达成小组共识的方法)的练习以及迭代匿名投票形成了共识,并得到了连续研究投入的支持。一项系统的范围审查确定了 70 种可能的结果和 107 种相关的测量工具。对这些措施在常规实践中的可行性(即简短、免费提供、在儿童和青少年中的验证以及语言翻译)和心理测量性能(即有效性、可靠性和对变化的敏感性)进行了评估。最终的标准集建议通过七种主要的患者报告结果测量来跟踪症状、自杀想法和行为以及功能:修订后的儿童焦虑和抑郁量表、儿童强迫症清单、儿童修订后的事件影响量表、哥伦比亚自杀严重程度评定量表、KIDSCREEN-10、儿童全球评估量表和儿童焦虑生活干扰量表。该标准集的建议通过涉及 45 个国家的 487 名参与者的反馈调查得到了验证。该标准集应与成人的焦虑和抑郁标准集一起使用,由临床医生选择适合年龄的测量方法。

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