Costello E J, Edelbrock C, Costello A J, Dulcan M K, Burns B J, Brent D
Department of Psychiatry, University of Pittsburgh.
Pediatrics. 1988 Sep;82(3 Pt 2):415-24.
In a study of emotional and behavioral problems seen in children attending pediatric primary care clinics in a health maintenance organization, parents of 789 children 7 to 11 years of age completed a behavior screening questionnaire, the Child Behavior Checklist. Of the 195 (24.7%) children identified by the checklist as disturbed, 126 were given a detailed psychiatric assessment using the Diagnostic Interview Schedule for Children, a structured psychiatric interview of known validity and reliability. A randomly selected group of 174 nondisturbed children was also assessed. The pediatricians' judgment about the presence of emotional and behavioral problems, made at the index clinic visit, was compared with diagnoses made from the computer-scored interviews. Pediatricians diagnosed one or more such problems in 5.6% of the children (weighted estimate: 95% confidence limits 3.8% to 7.6%), compared with 11.8% (95% confidence interval 9.3% to 13.5%) based on the interview with the parent. Pediatricians were highly specific, ie, 84% of children assessed as nondisturbed had no psychiatric disorder, but they showed low sensitivity, ie, they only identified 17% of the children with behavioral or emotional problems, giving a "hidden morbidity rate" of 83% (ie, 83% of cases were not identified). The role of primary care pediatricians in the identification, prevention and treatment of what has been called "the new morbidity" is discussed. We suggest that, on the basis of these findings, emotional and behavioral problems in children have to be seen as "the new hidden morbidity."
在一项针对健康维护组织中儿科初级保健诊所就诊儿童的情绪和行为问题的研究中，789名7至11岁儿童的家长完成了一份行为筛查问卷——儿童行为量表。在该量表识别出的195名（24.7%）行为失常儿童中，126名儿童接受了使用儿童诊断访谈量表进行的详细精神科评估，这是一种效度和信度已知的结构化精神科访谈。还对随机抽取的174名行为正常儿童进行了评估。将儿科医生在首次诊所就诊时对儿童情绪和行为问题的判断与计算机评分访谈得出的诊断结果进行比较。儿科医生诊断出5.6%的儿童存在一个或多个此类问题（加权估计：95%置信区间为3.8%至7.6%），而基于对家长的访谈这一比例为11.8%（95%置信区间为9.3%至13.5%）。儿科医生的诊断具有高度特异性，即84%被评估为行为正常的儿童没有精神障碍，但敏感性较低，即他们仅识别出17%有行为或情绪问题的儿童，“隐性发病率”为83%（即83%的病例未被识别）。文中讨论了初级保健儿科医生在识别、预防和治疗所谓“新发病率”方面的作用。我们建议，基于这些研究结果，儿童的情绪和行为问题应被视为“新的隐性发病率”。
