Davies Molly R, Buckman Joshua E J, Adey Brett N, Armour Chérie, Bradley John R, Curzons Susannah C B, Davies Helena L, Davis Katrina A S, Goldsmith Kimberley A, Hirsch Colette R, Hotopf Matthew, Hübel Christopher, Jones Ian R, Kalsi Gursharan, Krebs Georgina, Lin Yuhao, Marsh Ian, McAtarsney-Kovacs Monika, McIntosh Andrew M, Mundy Jessica, Monssen Dina, Peel Alicia J, Rogers Henry C, Skelton Megan, Smith Daniel J, Ter Kuile Abigail, Thompson Katherine N, Veale David, Walters James T R, Zahn Roland, Breen Gerome, Eley Thalia C
Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 7HB, UK; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK.
J Anxiety Disord. 2022 Jan;85:102491. doi: 10.1016/j.janxdis.2021.102491. Epub 2021 Oct 26.
Understanding and improving outcomes for people with anxiety or depression often requires large sample sizes. To increase participation and reduce costs, such research is typically unable to utilise "gold-standard" methods to ascertain diagnoses, instead relying on remote, self-report measures.
Assess the comparability of remote diagnostic methods for anxiety and depression disorders commonly used in research.
Participants from the UK-based GLAD and COPING NBR cohorts (N = 58,400) completed an online questionnaire between 2018 and 2020. Responses to detailed symptom reports were compared to DSM-5 criteria to generate symptom-based diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD), specific phobia, social anxiety disorder, panic disorder, and agoraphobia. Participants also self-reported any prior diagnoses from health professionals, termed self-reported diagnoses. "Any anxiety" included participants with at least one anxiety disorder. Agreement was assessed by calculating accuracy, Cohen's kappa, McNemar's chi-squared, sensitivity, and specificity.
Agreement between diagnoses was moderate for MDD, any anxiety, and GAD, but varied by cohort. Agreement was slight to fair for the phobic disorders. Many participants with self-reported GAD did not receive a symptom-based diagnosis. In contrast, symptom-based diagnoses of the phobic disorders were more common than self-reported diagnoses.
Agreement for MDD, any anxiety, and GAD was higher for cases in the case-enriched GLAD cohort and for controls in the general population COPING NBR cohort. For anxiety disorders, self-reported diagnoses classified most participants as having GAD, whereas symptom-based diagnoses distributed participants more evenly across the anxiety disorders. Further validation against gold standard measures is required.
了解并改善焦虑或抑郁患者的治疗效果通常需要大样本量。为了提高参与度并降低成本，此类研究通常无法采用“金标准”方法来确定诊断，而是依赖远程自我报告测量。
评估研究中常用的焦虑和抑郁障碍远程诊断方法的可比性。
来自英国的GLAD和应对NBR队列（N = 58400）的参与者在2018年至2020年间完成了一份在线问卷。将详细症状报告的回答与《精神疾病诊断与统计手册》第五版（DSM - 5）标准进行比较，以生成基于症状的重度抑郁症（MDD）、广泛性焦虑症（GAD）、特定恐惧症、社交焦虑症、惊恐障碍和广场恐惧症的诊断。参与者还自我报告了来自健康专业人员的任何先前诊断，称为自我报告诊断。“任何焦虑症”包括患有至少一种焦虑症的参与者。通过计算准确性、科恩卡方值、麦克尼马尔卡方值、敏感性和特异性来评估一致性。
MDD、任何焦虑症和GAD的诊断之间的一致性为中等，但因队列而异。恐惧症的一致性为轻微到一般。许多自我报告患有GAD的参与者没有得到基于症状的诊断。相比之下，基于症状的恐惧症诊断比自我报告诊断更常见。
在病例丰富的GLAD队列中的病例以及一般人群应对NBR队列中的对照中，MDD、任何焦虑症和GAD的一致性更高。对于焦虑症，自我报告诊断将大多数参与者归类为患有GAD，而基于症状的诊断则使参与者在焦虑症中分布更为均匀。需要对照金标准测量进行进一步验证。
