Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Neurogastroenterol Motil. 2021 Dec;33(12):e14297. doi: 10.1111/nmo.14297. Epub 2021 Nov 17.
Functional gastrointestinal (GI) disorders, also known as disorders of gut-brain interaction (DGBI), affect 40% of the global population. Up to two-thirds of patients with FGIDs experience a major psychological disorder making a thorough psychosocial assessment a critical part of patient care as it can impact treatment approach. Many psychological questionnaires exist in the clinical realm serving different purposes including screening for anxiety and depression, somatization symptoms, health-related anxiety, illness impact, and health-related quality of life. Given the abundance of questionnaires used to screen for similar psychiatric comorbidities, correlation between different instruments is needed to allow for pooling of data. In this issue of Neurogastroenterology & Motility, Snijkers et al. conducted the first comparative study to assess the correlation between the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to determine optimal cutoffs for diagnosis of depressive and anxiety disorders in a cohort of irritable bowel syndrome patients. The biopsychosocial framework as it applies to FGID has led to the inclusion of both psychosocial assessments in clinical management and research protocols. Future directions include the development of symptom-specific questionnaires for groups of FGIDs, culturally specific psychosocial questionnaires, and inclusion of psychosocial well-being as primary or secondary outcomes in clinical research trials. In this review, we aim to explore the role of psychological questionnaires in clinical care and research trials and share practical tips on incorporating a biopsychosocial framework in the care of patients with FGIDs.
功能性胃肠病(GI),也称为肠脑相互作用障碍(DGBI),影响全球人口的 40%。高达三分之二的 FGIDs 患者患有主要心理障碍,因此全面的社会心理评估是患者护理的关键部分,因为它会影响治疗方法。临床领域存在许多心理问卷,用于不同的目的,包括筛查焦虑和抑郁、躯体化症状、健康相关焦虑、疾病影响和健康相关生活质量。鉴于用于筛查类似精神共病的问卷数量众多,需要对不同工具之间的相关性进行评估,以便能够合并数据。在本期《神经胃肠病学与动力学期刊》中,Snijkers 等人进行了首次比较研究,以评估医院焦虑和抑郁量表(HADS)和患者健康问卷-9(PHQ-9)与广泛性焦虑障碍-7(GAD-7)之间的相关性,以确定在肠易激综合征患者队列中诊断抑郁和焦虑障碍的最佳截断值。FGID 的生物心理社会框架导致将社会心理评估纳入临床管理和研究方案。未来的方向包括为 FGID 群体开发特定症状的问卷、具有文化特异性的社会心理问卷,以及将社会心理幸福感作为临床研究试验的主要或次要结果纳入。在这篇综述中,我们旨在探讨心理问卷在临床护理和研究试验中的作用,并分享在 FGIDs 患者护理中纳入生物心理社会框架的实用技巧。