Smith P
Br J Gen Pract. 1998 Sep;48(434):1565-9.
The patient self-rating questionnaire is commonly used as a research tool to identify patients with 'unrecognized' depression. There is no evidence to support its use as a clinical tool in general practice.
To determine whether use of the 30-item general health questionnaire (GHQ) is a practical means of increasing identification of 'new' episodes of emotional distress among patients consulting their general practitioner (GP).
A randomized controlled trial was carried out in a Scottish new town practice with eight partners. In the waiting room, 1912 patients aged over 14 years and consulting over a 10-month period attempted to complete the GHQ. The 'clinical judgement' group posted the questionnaire into a box then attended the doctor as normal. The 'screened' group presented the questionnaire to the doctor. After the consultation, the doctor completed an assessment questionnaire. The main outcome measures were GHQ scores and doctors' assessments of mental health.
In total, 1589 patients were eligible to participate. However, 207 patients in the screened group were excluded because the doctor did not look at the questionnaire. The clinical judgement group (59.7% patients) and the screened group (40.3%) were compared. Although the doctors' diagnoses of distress were low in the clinical judgement group (8.1%), they were significantly greater in the screened group (13.9%) where the diagnosis of depression was doubled. The percentage of patients scoring greater than or equal to 9 (GHQ+) was 21.5% and 21.0% respectively. The level of agreement between the doctors' diagnoses of distress and the questionnaires scoring GHQ+ rose from 19% in the clinical judgement group to 35% in the screened group.
The general health questionnaire used in a practice setting increases the identification of patients with emotional distress. However, the use made of the questionnaires in the screened group raises questions of doctor and patient acceptability.
患者自评问卷通常用作研究工具，以识别患有“未被识别”抑郁症的患者。但尚无证据支持其在全科医疗中作为临床工具使用。
确定使用30项一般健康问卷（GHQ）是否是一种切实可行的方法，以增加在咨询全科医生（GP）的患者中识别“新”发情绪困扰发作的几率。
在一个有八名合伙人的苏格兰新镇诊所进行了一项随机对照试验。在候诊室，1912名年龄超过14岁且在10个月期间前来咨询的患者尝试完成GHQ。“临床判断”组将问卷放入一个盒子，然后像往常一样看医生。“筛查”组将问卷交给医生。会诊后，医生完成一份评估问卷。主要结局指标为GHQ得分和医生对心理健康的评估。
共有1589名患者符合参与条件。然而，筛查组中有207名患者被排除，因为医生未查看问卷。对临床判断组（59.7%的患者）和筛查组（40.3%）进行了比较。尽管临床判断组中医生对困扰的诊断率较低（8.1%），但在筛查组中显著更高（13.9%），其中抑郁症的诊断率翻倍。得分大于或等于9分（GHQ+）的患者百分比分别为21.5%和21.0%。医生对困扰的诊断与问卷GHQ+得分之间的一致性水平从临床判断组的19%升至筛查组的35%。
在实际诊疗环境中使用一般健康问卷可增加对情绪困扰患者的识别。然而，筛查组中问卷的使用引发了医生和患者可接受性的问题。
