Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
Adm Policy Ment Health. 2021 Sep;48(5):768-779. doi: 10.1007/s10488-021-01127-5. Epub 2021 Mar 17.
To examine the agreement between patient and psychiatrist ratings of subjective well-being in people with schizophrenia using three well-being measurements: Satisfaction with Life, Subjective Happiness, and Subjective Well-being under Neuroleptic Treatment (SWN), including the SWN-subscale, and to investigate whether the psychiatrist's judgement or the psychiatrist-rated SWN is better at defining patient well-being. Patients with schizophrenia (n = 150) completed the three well-being measurements, then met psychiatrists, and their well-being was judged as either 'poor' or 'adequate' via the usual clinical assessment before being assessed again by the psychiatrist using the same measurements. Intra-class correlation was used to analyze the absolute agreement between 'patient-rated' and 'psychiatrist-rated' scores. Agreements on 'adequate' well-being status between patient-rated SWN (≥ 80; gold standard), psychiatrist-rated SWN, and psychiatrist's judgement were calculated using Kappa coefficients. We also calculated the sensitivity and specificity of the psychiatrist's judgement and the psychiatrist-rated SWN to define adequate well-being. SWN showed the strongest absolute agreement between patient-psychiatrist ratings (ICC = 0.7, p = 0.005), with physical functioning yielding the highest and self-control the lowest coefficients. The psychiatrist-rated SWN showed a better Kappa coefficient (0.4, p < 0.001) than the psychiatrist's judgement. Clinical judgement showed a 67% sensitivity and a 64% specificity, whereas the psychiatrist-rated SWN (score 93, AUC 81.4%) showed a 74% sensitivity and a 74% specificity for well-being prediction. The use of SWN by psychiatrists yielded a better alignment of well-being than the psychiatrist's judgement alone. The SWN subscale could help fill the gap between clinician and patient views on well-being. Psychiatrists should upskill in assessing patient wellbeing for appropriate treatment provision.
为了使用三种幸福感测量方法（生活满意度、主观幸福感和神经阻滞剂治疗下的主观幸福感（SWN），包括 SWN 子量表）来检验精神分裂症患者的主观幸福感在患者和精神科医生评分之间的一致性，并探讨精神科医生的判断或精神科医生评定的 SWN 是否更能定义患者的幸福感，我们纳入了 150 名精神分裂症患者，让他们完成了三种幸福感测量，然后与精神科医生会面，在接受同样的测量之前，由精神科医生通过常规临床评估将他们的幸福感判断为“差”或“尚可”，并再次对他们进行评估。我们使用组内相关系数分析“患者自评”和“精神科医生评定”评分之间的绝对一致性。使用 Kappa 系数计算患者自评的 SWN（≥80；金标准）、精神科医生评定的 SWN 和精神科医生判断之间的“尚可”幸福感状态的一致性。我们还计算了精神科医生判断和精神科医生评定的 SWN 来定义尚可幸福感的敏感性和特异性。SWN 显示了患者-精神科医生评分之间最强的绝对一致性（ICC=0.7，p=0.005），其中物理功能的系数最高，自我控制的系数最低。精神科医生评定的 SWN 显示出更好的 Kappa 系数（0.4，p<0.001）。临床判断的敏感性为 67%，特异性为 64%，而精神科医生评定的 SWN（评分 93，AUC 81.4%）的敏感性和特异性分别为 74%和 74%，用于幸福感预测。与仅使用精神科医生判断相比，精神科医生使用 SWN 可以更好地协调幸福感。SWN 子量表可以帮助填补临床医生和患者对幸福感的看法之间的差距。精神科医生应该提高评估患者幸福感的技能，以便提供适当的治疗。
