問卷可能協助初級照護時篩檢青少年是否有憂鬱問題


  【24drs.com】April 13, 2010 — 根據一項於4月5日線上發表於兒科醫學(Pediatrics)的研究結果,病患健康問卷2項篩檢表(PHQ-2)在偵測青少年重鬱症上有很好的敏感度與專一度。
  
  來自西雅圖華盛頓醫學院的Laura P. Richardson醫師與其同事們寫到,美國預防性服務任務小組建議對青少年進行憂鬱症篩檢。然而,很少有工具針對接受初級照護的青少年進行確效。目前並沒有檢驗簡短2項篩檢表用於青少年篩檢的研究。
  
  這項研究的目的在於評估PHQ-2使用於青少年的效度。試驗樣本包括499位年輕、年齡介於13~17歲,收納到整合健康系統的青少年。在完成一份簡短憂鬱症的篩檢後,這些青少年被邀請進行一份完整的評估,包括較長版本的憂鬱症篩檢指標(PHQ 9項憂鬱篩檢表),以及一份結構性精神健康訪談(兒童憂鬱症診斷性訪談時程模組[DISC-IV])。總共有444位青少年(89%)完成整份評估,研究團隊測試診斷標準的效度且透過評估PHQ-2與其他憂鬱症測量標準以及功能性受損的關聯性。
  
  以PHQ-2分數3分以上作為閾值,在找出符合精神疾患診斷與統計手冊第四版,DISC-IV重鬱症的標準,敏感度為74%,專一度為75%。在偵測這些青少年是否符合PHQ-9上可能重鬱症的標準時,敏感度為96%,專一度為82%。
  
  根據接受者操作特徵分析,PHQ-2的曲線下面積為0.84(95%信賴區間為0.75-0.92)。閾值訂為3分可以得到最大的敏感度且不會失去偵測憂鬱症的專一性。相較於PHQ-2分數低於3分的年輕人,那些PHQ-2分數高於3分者,功能受損分數顯著較高,而父母報告的內在化問題分數同樣顯著較高。
  
  這項研究的限制包括缺乏推廣到所有青少年族群的一般性、可能的選擇性誤差、以及DISC-IV及PHQ-2在時間上的差異。除此之外,PHQ-2是PHQ-9的一部份,如果分開進行的話,這些結果應該高度相關,且敏感度與專一度可能會稍微低一些。
  
  試驗作者們寫到,PHQ-2在偵測重鬱症上有良好的敏感度與專一度。這些特性,加上問卷較為精簡,使得這些工具在作為青少年憂鬱症初級照護篩檢上是很有潛力的。
  
  健康社區基金會兒童與青少年資助計劃、華盛頓大學皇家研究基金、一間西雅圖兒童醫院委員會獎助金、以及國家精神健康機構贊助這項研究。研究作者們表示沒有相關資金上的往來。

Questionnaire May Help Screen Teens for Major Depression in Primary Care

By Laurie Barclay, MD
Medscape Medical News

April 13, 2010 — The Patient Health Questionnaire 2-item depression screen (PHQ-2) has good sensitivity and specificity for the detection of major depression among adolescents, according to the results of a study reported online April 5 in Pediatrics.

"The US Preventive Services Task Force recommends screening for depression among adolescents," write Laura P. Richardson, MD, from University of Washington School of Medicine in Seattle, and colleagues. "However, few tools have been validated among adolescents in primary care settings. No studies have examined brief 2-item screening tools among adolescents."

The goal of the study was to assess the validity of the PHQ-2 among adolescents. The study sample consisted of 499 youth, aged 13 to 17 years, who were enrolled in an integrated healthcare system. After completing a brief depression screen, these adolescents were invited to undergo a full assessment, including a longer depression-screening scale (PHQ 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children depression modules [DISC-IV]). A total of 444 adolescents (89%) completed the full evaluation, and the investigators tested criterion validity and construct validity by evaluating associations between the PHQ-2 and other measures of depression and functional impairment.

With a cutoff PHQ-2 score of 3 or more, sensitivity was 74%, and specificity was 75% for identifying youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the DISC-IV. Sensitivity was 96%, and specificity was 82% for detecting adolescents who met criteria for probable major depression on the PHQ-9.

Area under the curve was 0.84 (95% confidence interval, 0.75 - 0.92) for the PHQ-2, based on receiver operating characteristic analysis. A cutoff point of 3 allowed maximal sensitivity without loss of specificity for identifying major depression. Compared with youth who had PHQ-2 scores of less than 3, those with a PHQ-2 score of 3 or more had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems.

Limitations of this study include lack of generalizability to all adolescent populations, possible selection bias, and time-window differences between the DISC-IV and the PHQ-2. In addition, PHQ-2 was part of the PHQ-9; therefore, the results should be highly correlated, and the sensitivity and specificity may be slightly lower if they were administered separately.

"The PHQ-2 has good sensitivity and specificity for detecting major depression," the study authors write. "These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care."

The Group Health Community Foundation Child and Adolescent Grant Program, the University of Washington Royalty Research Fund, a Seattle Children's Hospital Steering Committee Award, and the National Institute of Mental Health supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 5, 2010.

    
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