Screening high-risk patients and assisting in diagnosing anxiety in primary care: the Patient Health Questionnaire evaluated

BMC Psychiatry

Christina M Van der Feltz-Cornelis⁶  Philip Spinhoven⁴  Anton JLM Van Balkom¹  Herman J Adèr³  Harm WJ Van Marwijk²  Eric W De Heer⁵  Anna DT Muntingh¹ 

[1]Department of Psychiatry, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, Amsterdam 1081 HL, The Netherlands

[2]Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Van der Boechorststraat 7, Amsterdam 1081BT, The Netherlands

[3]Johannes van Kessel Advising, Wederkuil 11, Huizen 1273SB, The Netherlands

[4]Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, Leiden 2300 RC, The Netherlands

[5]Faculty of Social Sciences, Tranzo department, Tilburg University, PO Box 90153, Tilburg 5000 LE, The Netherlands

[6]Clinical Centre for Body, Mind and Health, GGZ Breburg, Lage Witsiebaan 4, Tilburg 5042 DA, The Netherlands

关键词: Criterion validity;    Case finding;    Screening;    Primary care;    Patient health questionnaire;    Anxiety disorder;   

Others  :  1124001
DOI  :  10.1186/1471-244X-13-192

 received in 2013-06-05, accepted in 2013-07-10,  发布年份 2013

【 摘 要 】

Background

Questionnaires may help in detecting and diagnosing anxiety disorders in primary care. However, since utility of these questionnaires in target populations is rarely studied, the Patient Health Questionnaire anxiety modules (PHQ) were evaluated for use as: a) a screener in high-risk patients, and/or b) a case finder for general practitioners (GPs) to assist in diagnosing anxiety disorders.

Methods

A cross-sectional analysis was performed in 43 primary care practices in the Netherlands. The added value of the PHQ was assessed in two samples: 1) 170 patients at risk of anxiety disorders (or developing them) according to their electronic medical records (high-risk sample); 2) 141 patients identified as a possible ‘anxiety case’ by a GP (GP-identified sample). All patients completed the PHQ and were interviewed using the Mini International Neuropsychiatric interview to classify DSM-IV anxiety disorders. Psychometric properties were calculated, and a logistic regression analysis was performed to assess the diagnostic value of the PHQ.

Results

Using only the screening questions of the PHQ, the area under the curve was 83% in the high-risk sample. In GP-identified patients the official algorithm showed the best characteristics with an area under the curve of 77%. Positive screening questions significantly increased the odds of an anxiety disorder diagnosis in high-risk patients (odds ratio = 23.4; 95% confidence interval 6.9 to 78.8) as did a positive algorithm in GP-identified patients (odds ratio = 13.9; 95% confidence interval 3.8 to 50.6).

Conclusions

The PHQ screening questions can be used to screen for anxiety disorders in high-risk primary care patients. In GP-identified patients, the benefit of the PHQ is less evident.

【 授权许可】

   
2013 Muntingh et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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