Langenbucher J, Labouvie E, Morgenstern J
Research Diagnostic Project, Rutgers-State University of New Jersey, Piscataway 08855-0969, USA.
J Consult Clin Psychol. 1996 Dec;64(6):1285-9. doi: 10.1037//0022-006x.64.6.1285.
Diagnostic agreement tests the reliability and concordance of diagnostic systems. The introduction of measures of agreement with reputations for baserate independence (e.g., Yule's Y and Q), and new studies occasioned by the publication of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases--10 (ICD-10; World Health Organization, 1992) make it necessary to study the relationship of illness baserates to measures of agreement. Testing diagnostic concordance for diagnoses of drug dependence from the third edition of the DSM (American Psychiatric Association, 1980) versus DSM-IV diagnoses of drug dependence under 3 baserate conditions, it was found that Yule's Y and Q proved as vulnerable to differences in baserates as kappa or percent agreement and that specificity covaried with baserate rather than being fixed, as most theoretical discussions assume. The uncritical use of Y and Q, therefore, is likely to lead to optimistic interpretations of agreement. Kappa should be preferred for most purposes, although an adjustment to the computational formulas for Y and Q is presented that can diminish their positive bias.
诊断一致性检验诊断系统的可靠性和一致性。引入与基础率独立性声誉相关的一致性测量方法（如尤尔氏Y和Q），以及因《精神疾病诊断与统计手册》（第4版；DSM-IV；美国精神病学协会，1994年）和《国际疾病分类第10版》（ICD-10；世界卫生组织，1992年）的出版而引发的新研究，使得有必要研究疾病基础率与一致性测量方法之间的关系。在三种基础率条件下，对DSM第三版（美国精神病学协会，1980年）与DSM-IV药物依赖诊断的诊断一致性进行测试，结果发现，尤尔氏Y和Q与卡方或百分比一致性一样，容易受到基础率差异的影响，而且特异性与基础率相关，而不是像大多数理论讨论所假设的那样是固定不变的。因此，不加批判地使用Y和Q可能会导致对一致性的乐观解释。在大多数情况下，应首选卡方，不过本文提出了对Y和Q计算公式的调整方法，可减少它们的正偏差。
