Poor performance of PHQ-9 and GAD-7 in screening clinical depression and anxiety among a large sample of Chinese children and adolescents.

IF 3.4 2区 医学 Q2 PSYCHIATRY
Sifan Wang, Jin Lu, Guiqing Zheng, Yandie He, Shuqing Liu, Yi Xiang, Xinyi Liu, Xiang Wang, Yuanyuan Xiao
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Abstract

Background: The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) are widely used symptom-based instruments for screening depression and anxiety. However, their validation in Chinese children and adolescents remains insufficient. We aim to investigate the performance and optimal cut-offs of PHQ-9 and GAD-7 in Chinese children and adolescents in screening clinical depression and anxiety, and to discuss the influencing factors of the cut-offs.

Methods: The study subjects were chosen from 3 sites of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a total of 2,237 participants who had been screened positive by self-administered questionnaire and further diagnosed by using the gold standard were included in the final analysis. The Receiver Operating Characteristic (ROC) curves were used to determine the discriminative ability of the two instruments, measured by using the area under curve (AUC). The optimal cut-offs of the two instruments were determined by the maximum Youden's index. A series of stratified analyses were performed to discover the best cut-offs for children and adolescents of different characteristics. Logistic regression models were adopted to evaluate the influence of self-harm (SH) on identified optimal cut-offs.

Results: We found the performance was generally poor for both the PHQ-9 and GAD-7 in screening clinical depression and anxiety in our study sample, with the AUCs ranged only between 0.622-0.712. When using the two instruments for diagnosis purpose, 11 was the optimal cut-off for both clinical depression and anxiety (AUC for PHQ-9: 0.664, AUC for GAD-7: 0.669). For study subjects of different age, gender, race, and left-behind status, discordant cut-offs were identified. SH also showed conspicuous influence on the optimal cut-offs of PHQ-9 and GAD-7, and the combination of SH information can increase screening accuracy of PHQ-9 in some subgroups.

Conclusions: Both the PHQ-9 and GAD-7 showed poor performance in screening clinical depression and anxiety in our study sample. This crucial finding suggests that, despite the wide use of the two scales, they might be fundamentally inadequate for depression and anxiety screening in Chinese children and adolescents. Other screening tools of higher accuracy should be developed and used in this age group.

PHQ-9和GAD-7在筛查大量中国儿童和青少年临床抑郁和焦虑方面表现不佳。
背景:患者健康问卷(PHQ-9)和广泛性焦虑障碍量表(GAD-7)是广泛使用的基于症状的抑郁和焦虑筛查工具。然而,它们在中国儿童和青少年中的验证仍然不足。目的探讨PHQ-9和GAD-7在中国儿童青少年临床抑郁和焦虑筛查中的表现及最佳截点,并探讨截点的影响因素。方法:研究对象选择自云南省儿童青少年心理健康调查(MHSCAY)的3个站点,通过自填问卷筛选阳性并采用金标准诊断的2237名参与者作为最终分析对象。采用受试者工作特征(ROC)曲线,用曲线下面积(AUC)测定两种仪器的判别能力。两种仪器的最佳截止点由最大约登指数确定。我们进行了一系列的分层分析,以发现不同特征的儿童和青少年的最佳临界值。采用Logistic回归模型评价自残对确定的最佳截止点的影响。结果:我们发现在我们的研究样本中,PHQ-9和GAD-7在筛查临床抑郁和焦虑方面的表现普遍较差,auc仅在0.622-0.712之间。当使用这两种工具进行诊断时,11是临床抑郁和焦虑的最佳截止值(PHQ-9的AUC为0.664,GAD-7的AUC为0.669)。对于不同年龄、性别、种族和留守状态的研究对象,发现了不一致的截断值。SH对PHQ-9和GAD-7的最佳截止值也有显著影响,结合SH信息可以提高某些亚组PHQ-9的筛选精度。结论:在我们的研究样本中,PHQ-9和GAD-7在筛查临床抑郁和焦虑方面表现不佳。这一重要发现表明,尽管这两种量表被广泛使用,但它们可能从根本上不足以用于中国儿童和青少年的抑郁和焦虑筛查。应该开发其他更高准确性的筛查工具,并在这一年龄组中使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Psychiatry
BMC Psychiatry 医学-精神病学
CiteScore
5.90
自引率
4.50%
发文量
716
审稿时长
3-6 weeks
期刊介绍: BMC Psychiatry is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of psychiatric disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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