心理解剖研究中SCID诊断准确性的影响因素

The influening factors of psychological autopsy SCID diagnostic accuracy

目的探讨心理解剖临床定式访谈(SCID)诊断准确性的影响因素。方法研究对象为大连市第七人民医院的就诊的209例患者和大连地区的144名社区人群。由经过统一培训的,并获得NIMH访谈员资格认证的研究人员对研究对象和信息人分别进行SCID访谈。结果①心理解剖SCID诊断的一致性较好:kappa值从抑郁障碍的0.696到精神分裂症的0.930;灵敏度从焦虑障碍的55.10%到精神分裂症的88.57%;特异度从抑郁障碍的95.70%到酒精使用障碍的100%。②不同类别的信息人心理解剖SCID诊断的一致率差异有统计学意义(P<0.05),其中一级亲属心理解剖SCID诊断一致率最高(P<0.05)。农村信息人心理解剖SCID诊断一致率高于城市,与患者同住高于不与患者同住,差异有统计学意义(P<0.05)。信息人学历越高,心理解剖SCID诊断一致率越高,差异有统计学意义(P<0.05)。结论心理解剖SCID诊断具有较好的灵敏度和特异度,与患者本人SCID诊断一致性良好。心理解剖SCID诊断精神疾病时尽可能选取一级亲属(父母或配偶)以及高学历者为信息提供者。

Objective The sensitivity and specificity of using psychological autopsies to diagnose a psychiatric disorder are a critical issue.Therefore,the sensitivity and specificity of the Structured Clinical Interview for DSM-IV AxisⅠand the usefulness of these instruments for the psychological autopsy method were investigated.In addition,the influencing factors of diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV Axis Ⅰwere discussed.Methods The subj ects of the research were the psychiatric patients of the No.7 people＇s hospital of Dalian and the community persons in the six counties in Liaoning province.Diagnoses by informant＇s interview were compared with diagnoses generated by a personal interview.Results The kappa coefficients of agreement by personal and informant＇s interview were from 0. 696 for anxiety disorder to 0.930 for schizophrenia;The specificity of most diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV AxisⅠwas higher than 88%,yet the sensitivity was lower than the specificity.The influencing factors of diagnoses obtained through the best-estimate method using the Structured Clinical Interview for DSM-IV AxisⅠwere category and education of the informants.Conclusion The sensitivity and specificity of using psychological autopsies to diagnose a psychiatric disorder were fair to excellent.The influencing factors of diagnoses by informant＇s interview were category and education of the informants.The Structured Clinical Interview for DSM-IV Axis Ⅰcan be recommended as a tool for the psychological autopsy research.