Wyshak G, Barsky A J
Department of Population and International Health, Harvard School of Public Health, Boston, Mass.
Arch Fam Med. 1994 May;3(5):419-24. doi: 10.1001/archfami.3.5.419.
To examine the relationship between patient self-ratings and physician ratings of general health, depression, and anxiety and patient and physician ratings in comparison to Diagnostic Interview Schedule (DIS) diagnoses of depression and anxiety.
Observational study.
A general medical outpatient clinic.
Clinic attendees.
Consecutive clinic attendees on randomly selected days completed a self-reported screening questionnaire for hypochondriasis, composed of the Whiteley Index and the Somatic Symptom Inventory. A random sample of patients (N = 79), 95% of whom had scores below the cutoff for hypochondriasis (n = 75) and 5% of whom had scores at or above the cutoff for hypochondriasis (N = 4), returned at a later date to complete a research battery consisting of self-reported questionnaires, structured and semistructured interviews, and a structured interview for diagnoses of anxiety and depression based on the DIS, which used criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.
Responses to questionnaires and interviews.
Agreement between patients and physicians was statistically significant concerning patients' physical health, depression, and anxiety. Based on one question, both physicians' and patients' ratings of depression and anxiety compared favorably with DIS diagnoses. By means of receiver operating characteristics analysis, values for the areas under the curve and their SEs were as follows: for depression, 0.789 +/- 0.075 for patient self-ratings and 0.825 +/- 0.054 for physician ratings; for anxiety, 0.734 +/- 0.058 for patient self-ratings and 0.667 +/- 0.065 for physician ratings.
One simple question about a patient's status with respect to depression or anxiety is sufficient to detect these disorders with high sensitivity and specificity, yielding values comparable to those yielded by instruments consisting of many items. Asking patients to rate their own levels of depression and anxiety may constitute one portion of the family physician's diagnostic assessment for these conditions.
探讨患者自我评分与医生对总体健康、抑郁和焦虑的评分之间的关系，以及将患者和医生的评分与基于诊断性访谈表（DIS）对抑郁和焦虑的诊断结果进行比较。
观察性研究。
一家普通内科门诊诊所。
诊所就诊者。
在随机选定的日子里，连续的诊所就诊者完成一份关于疑病症的自我报告筛查问卷，该问卷由怀特利指数和躯体症状量表组成。随机抽取一组患者（N = 79），其中95%的患者得分低于疑病症的临界值（n = 75），5%的患者得分等于或高于疑病症的临界值（N = 4），这些患者在之后返回完成一组研究项目，包括自我报告问卷、结构化和半结构化访谈，以及基于DIS的用于诊断焦虑和抑郁的结构化访谈，该访谈采用了《精神疾病诊断与统计手册》第三版修订本中的标准。
对问卷和访谈的回答。
在患者的身体健康、抑郁和焦虑方面，患者与医生之间的一致性具有统计学意义。基于一个问题，医生和患者对抑郁和焦虑的评分与DIS诊断结果相比表现良好。通过受试者工作特征分析，曲线下面积值及其标准误如下：对于抑郁，患者自我评分的曲线下面积为0.789±0.075，医生评分的曲线下面积为0.825±0.054；对于焦虑，患者自我评分的曲线下面积为0.734±0.058，医生评分的曲线下面积为0.667±0.065。
一个关于患者抑郁或焦虑状况的简单问题足以以高敏感性和特异性检测出这些疾病，得出的值与由许多项目组成的工具得出的值相当。让患者对自己的抑郁和焦虑水平进行评分可能构成家庭医生对这些病症诊断评估的一部分。
