Cao Jinya, Wei Jing, Fritzsche Kurt, Toussaint Anne Christin, Li Tao, Zhang Lan, Zhang Yaoyin, Chen Hua, Wu Heng, Ma Xiquan, Li Wentian, Ren Jie, Lu Wei, Leonhart Rainer
Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Centre - University of Freiburg, Freiburg im Breisgau, Germany.
Front Psychiatry. 2022 Oct 20;13:935597. doi: 10.3389/fpsyt.2022.935597. eCollection 2022.
This study investigates the diagnostic accuracy of the PHQ-15, SSS-8, SSD-12 and Whitley 8 and their combination in detecting DSM-5 somatic symptom disorder in general hospitals.
In our former multicenter cross-sectional study enrolling 699 outpatients from different departments in five cities in China, SCID-5 for SSD was administered to diagnose SSD and instruments including PHQ-15, SSS-8, SSD-12 and WI-8 were used to evaluate the SSD A and B criteria. In this secondary analysis study, we investigate which instrument or combination of instrument has best accuracy for detecting SSD in outpatients. Receiver operator curves were created, and area under the curve (AUC) analyses were assessed. The sensitivity and specificity were calculated for the optimal individual cut points.
Data from = 694 patients [38.6% male, mean age: 42.89 years (SD = 14.24)] were analyzed. A total of 33.9% of patients fulfilled the SSD criteria. Diagnostic accuracy was moderate or good for each questionnaire (PHQ-15: AUC = 0.72; 95% CI = 0.68-0.75; SSS-8: AUC = 0.73; 95% CI = 0.69-0.76; SSD-12: AUC = 0.84; 95% CI = 0.81-0.86; WI-8: AUC = 0.81; 95% CI = 0.78-0.84). SSD-12 and WI-8 were significantly better at predicting SSD diagnoses. Combining PHQ-15 or SSS-8 with SSD-12 or WI-8 showed similar diagnostic accuracy to SSD-12 or WI-8 alone (PHQ-15 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; PHQ-15 + WI-8: AUC = 0.82; 95% CI = 0.79-0.85; SSS-8 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; SSS-8 + WI-8: AUC = 0.82; 95% CI = 0.79-0.84). In the efficiency analysis, both SSD-12 and WI-8 showed good efficiency, SSD-12 slightly more efficient than WI-8; however, within the range of good sensitivity, the PHQ-15 and SSS-8 delivered rather poor specificity. For a priority of sensitivity over specificity, the cutoff points of ≥13 for SSD-12 (sensitivity and specificity = 80 and 72%) and ≥17 for WI-8 (sensitivity and specificity = 80 and 67%) are recommended.
In general hospital settings, SSD-12 or WI-8 alone may be sufficient for detecting somatic symptom disorder, as effective as when combined with the PHQ-15 or SSS-8 for evaluating physical burden.
本研究调查PHQ - 15、SSS - 8、SSD - 12和惠特利8量表及其组合在综合医院中检测DSM - 5躯体症状障碍的诊断准确性。
在我们之前的一项多中心横断面研究中，纳入了来自中国五个城市不同科室的699名门诊患者，采用SCID - 5进行SSD诊断，并使用包括PHQ - 15、SSS - 8、SSD - 12和WI - 8在内的工具评估SSD A和B标准。在这项二次分析研究中，我们调查哪种工具或工具组合在检测门诊患者的SSD方面具有最佳准确性。绘制了受试者工作特征曲线，并评估曲线下面积（AUC）分析。计算了最佳个体切点的敏感性和特异性。
分析了来自694例患者的数据[男性占38.6%，平均年龄：42.89岁（标准差 = 14.24）]。共有33.9%的患者符合SSD标准。每个问卷的诊断准确性为中等或良好（PHQ - 15：AUC = 0.72；95%置信区间 = 0.68 - 0.75；SSS - 8：AUC = 0.73；95%置信区间 = 0.69 - 0.76；SSD - 12：AUC = 0.84；95%置信区间 = 0.81 - 0.86；WI - 8：AUC = 0.81；95%置信区间 = 0.78 - 0.84）。SSD - 12和WI - 8在预测SSD诊断方面明显更好。将PHQ - 15或SSS - 8与SSD - 12或WI - 8结合显示出与单独使用SSD - 12或WI - 8相似的诊断准确性（PHQ - 15 + SSD - 12：AUC = 0.84；95%置信区间 = 0.81 - 0.87；PHQ - 15 + WI - 8：AUC = 0.82；95%置信区间 = 0.79 - 0.85；SSS - 8 + SSD - 12：AUC = 0.84；9�%置信区间 = 0.81 - 0.87；SSS - 8 + WI - 8：AUC = 0.82；95%置信区间 = 0.79 - 0.84）。在效率分析中，SSD - 12和WI - 8均显示出良好的效率，SSD - 12的效率略高于WI - 8；然而，在良好敏感性范围内，PHQ - 15和SSS - 8的特异性相当差。对于优先考虑敏感性而非特异性的情况，建议SSD - 12的切点≥13（敏感性和特异性分别为80%和72%），WI - 8的切点≥17（敏感性和特异性分别为80%和67%）。
在综合医院环境中，单独使用SSD - 12或WI - 8可能足以检测躯体症状障碍，在评估身体负担方面与与PHQ - 15或SSS - 8联合使用时一样有效。
