Rost K, Burnam M A, Smith G R
Center for Rural Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock 72205.
Med Care. 1993 Mar;31(3):189-200. doi: 10.1097/00005650-199303000-00001.
If screeners are going to be widely incorporated in clinical care to increase the detection of common psychiatric disorders, they need to be brief, easy to score, and sensitive across diverse patient populations. Few screeners exist that meet these criteria. This problem is addressed in this study by identifying a subset of questions from the Diagnostic Interview Schedule (DIS), which predicted simultaneously obtained DIS diagnoses. A two-item screener to detect depression or dysthymia within the last year and three-item screeners for lifetime drug disorders and alcohol disorders were tested in community residents, medical, and mental health patients. The sensitivity of the depression screener ranged between 83% and 94%. The sensitivity of the drug screener ranged between 91% and 94%, excluding one site with an extremely low prevalence of drug problems. The sensitivity of the alcohol screener ranged between 87% and 92%. Specificity for all three screeners exceeded 90% in community and medical samples, while being somewhat lower among mental health patients. These findings indicate that these brief screeners may be useful in a variety of epidemiologic studies to provide estimates of common psychiatric disorders when complete diagnostic interviews are not feasible. If further validation studies support these sensitivity and specificity estimates, these new instruments may also be valuable as initial brief screeners in a two-stage screening process to improve clinicians' recognition of common mental health problems that complicate case management and impair patient functioning.
如果筛查工具要广泛应用于临床护理以提高对常见精神障碍的检测率，那么它们需要简短、易于评分，并且在不同患者群体中都具有敏感性。符合这些标准的筛查工具很少。本研究通过从诊断访谈表（DIS）中识别出一组问题来解决这个问题，这些问题能预测同时获得的DIS诊断结果。在社区居民、内科患者和精神科患者中测试了一个用于检测过去一年中是否患有抑郁症或心境恶劣障碍的两项筛查工具，以及用于检测终生药物滥用障碍和酒精滥用障碍的三项筛查工具。抑郁症筛查工具的敏感性在83%至94%之间。药物筛查工具的敏感性在91%至94%之间，排除了一个药物问题患病率极低的地点。酒精筛查工具的敏感性在87%至92%之间。在社区和内科样本中，所有这三种筛查工具的特异性均超过90%，而在精神科患者中则略低。这些发现表明，当完整的诊断访谈不可行时，这些简短的筛查工具可能在各种流行病学研究中有用，可用于估计常见精神障碍的情况。如果进一步的验证研究支持这些敏感性和特异性估计，那么这些新工具作为两阶段筛查过程中的初始简短筛查工具，对于提高临床医生对常见心理健康问题的识别能力也可能具有价值，这些问题会使病例管理复杂化并损害患者的功能。
