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

BMC Psychiatry

Research Article

Harm WJ Van Marwijk¹  Anton JLM Van Balkom²  Philip Spinhoven³  Herman J Adèr⁴  Eric W De Heer⁵  Christina M Van der Feltz-Cornelis⁶  Anna DT Muntingh⁷ 

[1] EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, 1007 MB, Amsterdam, The Netherlands;Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands;EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, 1007 MB, Amsterdam, The Netherlands;Department of Psychiatry, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands;Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, The Netherlands;Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands;Johannes van Kessel Advising, Wederkuil 11, 1273SB, Huizen, The Netherlands;Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO box 725, 3500AS, Utrecht, The Netherlands;Faculty of Social Sciences, Tranzo department, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands;Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO box 725, 3500AS, Utrecht, The Netherlands;Faculty of Social Sciences, Tranzo department, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands;Clinical Centre for Body, Mind and Health, GGZ Breburg, Lage Witsiebaan 4, 5042 DA, Tilburg, The Netherlands;Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO box 725, 3500AS, Utrecht, The Netherlands;Faculty of Social Sciences, Tranzo department, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands;Department of Psychiatry, VU University Medical Centre and GGZ inGeest, A.J. Ernststraat 1187, 1081 HL, Amsterdam, The Netherlands;

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

DOI  :  10.1186/1471-244X-13-192

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

来源: Springer

【 摘 要 】

BackgroundQuestionnaires 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.MethodsA 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.ResultsUsing 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).ConclusionsThe 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】

CC BY   
© Muntingh et al.; licensee BioMed Central Ltd. 2013