在基层医疗中应用问卷既定临界值检测躯体症状障碍所获经验教训：一项横断面研究。
Lessons learned from applying established cut-off values of questionnaires to detect somatic symptom disorders in primary care: a cross-sectional study.
作者信息
von Schrottenberg Victoria, Toussaint Anne, Hapfelmeier Alexander, Teusen Clara, Riedl Bernhard, Henningsen Peter, Gensichen Jochen, Schneider Antonius, Linde Klaus
机构信息
Department Clinical Medicine, Institute of General Practice and Health Services Research, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
出版信息
Front Psychiatry. 2024 Jan 18;14:1289186. doi: 10.3389/fpsyt.2023.1289186. eCollection 2023.
INTRODUCTION
Based on two diagnostic accuracy studies in high-prevalence settings, two distinctly different combinations of cut-off values have been recommended to identify persons at risk for somatic symptom disorder (SSD) with the combination of the Patient-Health Questionnaire-15 (PHQ-15) and the Somatic Symptom Disorder-B Criteria Scale (SSD-12). We investigated whether the reported sensitivity and specificity of both recommended cut-off combinations are transferable to primary care.
METHODS
In a cross-sectional study, 420 unselected adult primary care patients completed PHQ-15 and SSD-12. Patients scoring ≥9 and ≥ 23 (recommended cut-off combination #1) or ≥ 8 and ≥ 13 (recommended cut-off combination #2) were considered test-positive for SSD, respectively. To assess the validity of the reported sensitivity and specificity in different low- to high-prevalence settings, we compared correspondingly expected proportions of test positives to the proportion observed in our sample.
RESULTS
Based on combination #1, 38 participants (9%) were found to be test positive, far fewer than expected, based on the reported values for sensitivity and specificity (expected minimum frequency 30% with a true prevalence ≥1%). This can only be explained by a lower sensitivity and higher specificity in primary care. For combination #2, 98 participants (23%) were test positive, a finding consistent with a true prevalence of SSD of 15% or lower.
DISCUSSION
Our analyzes strongly suggest that the sensitivity and specificity estimates reported for combination #1 are not applicable to unselected primary care patients and that the cut-off for the SSD (≥23) is too strict. Cut-off combination #2 seems more applicable but still needs to be tested in studies that compare screening findings by questionnaires with validated diagnostic interviews as reference standards in primary care populations.
引言
基于两项在高患病率环境下的诊断准确性研究，推荐了两种截然不同的临界值组合，用于结合患者健康问卷15项（PHQ - 15）和躯体症状障碍B标准量表（SSD - 12）来识别有躯体症状障碍（SSD）风险的人群。我们调查了这两种推荐临界值组合所报告的敏感性和特异性是否可转移至初级保健领域。
方法
在一项横断面研究中，420名未经挑选的成年初级保健患者完成了PHQ - 15和SSD - 12的测评。分别将得分≥9分和≥23分（推荐临界值组合#1）或≥8分和≥13分（推荐临界值组合#2）的患者视为SSD检测呈阳性。为评估在不同低至高患病率环境下所报告的敏感性和特异性的有效性，我们将相应预期的检测阳性比例与我们样本中观察到的比例进行了比较。
结果
基于组合#1，发现38名参与者（9%）检测呈阳性，远低于基于所报告的敏感性和特异性值预期的数量（在真实患病率≥1%时，预期最低频率为30%）。这只能通过初级保健中较低的敏感性和较高的特异性来解释。对于组合#2，98名参与者（23%）检测呈阳性，这一结果与SSD真实患病率为15%或更低相符。
讨论
我们的分析强烈表明，组合#1所报告的敏感性和特异性估计不适用于未经挑选的初级保健患者，且SSD的临界值（≥23）过于严格。临界值组合#2似乎更适用，但仍需在将问卷筛查结果与经过验证的诊断性访谈作为初级保健人群参考标准进行比较的研究中进行测试。
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