Costello E J, Burns B J, Costello A J, Edelbrock C, Dulcan M, Brent D
Department of Psychiatry, University of Pittsburgh.
Pediatrics. 1988 Sep;82(3 Pt 2):435-41.
Levels of morbidity in 789 children 7 to 11 years of age attending two primary care pediatric clinics in a health maintenance organization were examined in relation to psychiatric disturbance. Physical morbidity was measured as mean number of illness episodes per year enrolled, based on the child's medical record. Two measures of psychiatric disturbance were compared: the pediatricians' judgment and a detailed assessment using standard psychiatric interviews with parent and child. Children identified by pediatricians as disturbed had more than twice as many physical illness episodes as nonidentified children. Children identified by the standard psychiatric assessment had the same number of physical illness episodes as nondisturbed children. Pediatricians showed high specificity but low sensitivity to mental illness. Their sensitivity in the high user group was double that in the low user group. These results suggest that (1) the association between mental illness and high use may be, in part, the result of the confounding factor of physicians' judgment; (2) in settings where primary care practitioners serve as "gatekeepers" to mental health services, the offset effect of lower medical service use following psychiatric treatment may be partially explained by this; (3) the source of referral must be taken into account when assessing the offset effect in other settings.
对健康维护组织中两家初级保健儿科诊所的789名7至11岁儿童的发病率与精神障碍的关系进行了研究。身体发病率以根据儿童病历计算的每年登记的疾病发作平均次数来衡量。比较了两种精神障碍测量方法：儿科医生的判断以及使用对家长和孩子的标准精神科访谈进行的详细评估。被儿科医生认定为有精神障碍的儿童的身体疾病发作次数是非认定儿童的两倍多。通过标准精神科评估认定的儿童的身体疾病发作次数与无精神障碍儿童相同。儿科医生对精神疾病表现出高特异性但低敏感性。他们在高使用组中的敏感性是低使用组中的两倍。这些结果表明：（1）精神疾病与高使用率之间的关联可能部分是医生判断这一混杂因素的结果；（2）在初级保健从业者作为心理健康服务“守门人”的环境中，精神科治疗后较低的医疗服务使用率的抵消效应可能部分由此得到解释；（3）在评估其他环境中的抵消效应时，必须考虑转诊来源。
