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健康问卷-9筛查重度抑郁症患者的准确性荟萃分析
作者:小柯机器人 发布时间:2021/10/10 22:44:09

加拿大犹太总医院Brett D Thombs团队研究了筛查重度抑郁症患者健康问卷9的准确性。相关论文于2021年10月5日发表在《英国医学杂志》上。

为了更新之前的个体参与者数据荟萃分析,并确定患者健康问卷-9(PHQ-9)的准确性(该问卷是一般实践中最常用的抑郁症筛查工具,通过研究参与者亚组来检测总体抑郁症),研究组在Medline和Medline In Process等大型数据库中检索截至2018年5月9日的相应研究,并进行系统回顾和个体参与者数据荟萃分析。

符合条件的研究使用PHQ-9,并使用经验证的半结构化诊断访谈(为临床医生管理而设计)、全结构化访谈(为非专业管理而设计)或小型国际神经精神访谈(小型;为非专业管理人员设计的简短采访)对当前的抑郁症状态进行分类。在使用半结构化诊断访谈(例如,诊断和统计手册的结构化临床访谈)、全结构化访谈(例如,综合国际诊断访谈)和小型访谈中,采用双变量随机效应荟萃分析模型,分别在临界值5-15获得PHQ-9敏感性和特异性的点和区间估计值。元回归用于调查PHQ-9的准确性是否与参考标准类别和参与者特征相关。

研究组从127项合格研究中筛选出100项(42项额外研究;79%的研究符合条件;86%的参与者符合资格),涉及44 503名参与者。在采用半结构化访谈参考标准的研究中,将PHQ-9的敏感性和特异性汇集在标准临界值≥10,使综合敏感性和特异性最大化,分别为0.85和0.85。各参考标准的特异性相似,但半结构访谈研究的敏感性临界值比全结构访谈的参考标准高7-24%,比小型访谈高2-14%。在参考标准和临界值中,男性的特异性高出0-10%,60岁或以上人群的特异性高出0-12%。

研究人员和临床医生可以使用www.depressionscreening100.com/PHQ上的知识翻译工具,在不同临床设置的不同PHQ-9临界值下,使用问卷结果来确定诊断,如阳性筛查和假阳性筛查的总数。

附:英文原文

Title: Accuracy of the Patient Health Questionnaire-9 for screening to detect major depression: updated systematic review and individual participant data meta-analysis

Author: Zelalem F Negeri, Brooke Levis, Ying Sun, Chen He, Ankur Krishnan, Yin Wu, Parash Mani Bhandari, Dipika Neupane, Eliana Brehaut, Andrea Benedetti, Brett D Thombs

Issue&Volume: 2021/10/05

Abstract:

Objective To update a previous individual participant data meta-analysis and determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9), the most commonly used depression screening tool in general practice, for detecting major depression overall and by study or participant subgroups.

Design Systematic review and individual participant data meta-analysis.

Data sources Medline, Medline In-Process, and Other Non-Indexed Citations via Ovid, PsycINFO, Web of Science searched through 9 May 2018.

Review methods Eligible studies administered the PHQ-9 and classified current major depression status using a validated semistructured diagnostic interview (designed for clinician administration), fully structured interview (designed for lay administration), or the Mini International Neuropsychiatric Interview (MINI; a brief interview designed for lay administration). A bivariate random effects meta-analytic model was used to obtain point and interval estimates of pooled PHQ-9 sensitivity and specificity at cut-off values 5-15, separately, among studies that used semistructured diagnostic interviews (eg, Structured Clinical Interview for Diagnostic and Statistical Manual), fully structured interviews (eg, Composite International Diagnostic Interview), and the MINI. Meta-regression was used to investigate whether PHQ-9 accuracy correlated with reference standard categories and participant characteristics.

Results Data from 44503 total participants (27146 additional from the update) were obtained from 100 of 127 eligible studies (42 additional studies; 79% eligible studies; 86% eligible participants). Among studies with a semistructured interview reference standard, pooled PHQ-9 sensitivity and specificity (95% confidence interval) at the standard cut-off value of ≥10, which maximised combined sensitivity and specificity, were 0.85 (0.79 to 0.89) and 0.85 (0.82 to 0.87), respectively. Specificity was similar across reference standards, but sensitivity in studies with semistructured interviews was 7-24% (median 21%) higher than with fully structured reference standards and 2-14% (median 11%) higher than with the MINI across cut-off values. Across reference standards and cut-off values, specificity was 0-10% (median 3%) higher for men and 0-12 (median 5%) higher for people aged 60 or older.

Conclusions Researchers and clinicians could use results to determine outcomes, such as total number of positive screens and false positive screens, at different PHQ-9 cut-off values for different clinical settings using the knowledge translation tool at www.depressionscreening100.com/phq.

DOI: 10.1136/bmj.n2183

Source: https://www.bmj.com/content/375/bmj.n2183

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj