PRIME-MD / PHQ Clinical Screening Framework
Spitzer, R. L., Kroenke, K. & Williams, J. B. W. · 1999
เป็นที่รู้จักในชื่อ: PRIME-MD · PHQ Framework
The PHQ family descends from the Primary Care Evaluation of Mental Disorders and applies a single design principle: map each questionnaire item directly onto a diagnostic criterion, so that a non-specialist can administer it and a positive screen points to a specific follow-up rather than to generalised concern. The PHQ-9 covers the nine DSM criteria for major depressive episode over the last two weeks; the PHQ-2 is its two-item first stage; the PHQ-15 covers somatic symptom burden. These are screening instruments with published sensitivity and specificity — they identify who warrants assessment, and they do not diagnose.
Clinical screening framework derived from the Primary Care Evaluation of Mental Disorders (PRIME-MD). Operationalizes DSM-IV diagnostic criteria into brief self-report screeners for depression (PHQ-9/PHQ-2), anxiety (GAD-7), somatization (PHQ-15), and other conditions. Not a diagnostic system — designed to identify probable cases for clinical follow-up.
- แหล่งที่มา:
- Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282(18), 1737-1744.
ทำแบบทดสอบที่ผ่านการตรวจสอบซึ่งสร้างบนทฤษฎีนี้
การอ่านเกี่ยวกับโครงสร้างจะบอกคุณว่ามันคืออะไร เครื่องมือที่ผ่านการตรวจสอบจะบอกคุณว่าคุณอยู่ตรงไหน ทำฟรี ผลลัพธ์ภายในไม่กี่นาที
ภาพรวมหลักฐาน
- การสนับสนุนเชิงประจักษ์
- หลักฐานแข็งแกร่ง
- การทำซ้ำ
- ทำซ้ำได้ดี
- ข้ามวัฒนธรรม
- ส่วนใหญ่เป็นสากล
- การวิเคราะห์อภิมาน
- 30 ที่จัดทำดัชนี
คะแนนเหล่านี้สรุปจากวรรณกรรมที่ตีพิมพ์เกี่ยวกับทฤษฎี ไม่ใช่คุณภาพของแบบทดสอบใด ๆ ที่สร้างบนทฤษฎีนี้ เป็นการประเมินจากบรรณาธิการตามแหล่งข้อมูลด้านล่าง และจะเปลี่ยนแปลงเมื่อมีหลักฐานเพิ่มเติม
บริบททางประวัติศาสตร์
PRIME-MD, published by Spitzer and colleagues in 1994, was a clinician-administered instrument designed to bring structured psychiatric assessment into general practice, but it took too long for routine use. The 1999 self-administered Patient Health Questionnaire was the response, and Kroenke, Spitzer and Williams's 2001 validation of the PHQ-9 made it the most widely used depression screen in the world. Its adoption was accelerated by being free of licensing cost, and it now anchors measurement-based care and collaborative-care models in many health systems.
โครงสร้าง
Depression Severity
As operationalized in the PHQ-9 and PHQ-2 (Kroenke, Spitzer & Williams, 2001), depression severity is assessed by the frequency of the nine cardinal symptoms of Major Depressive Disorder specified in DSM-IV: anhedonia, depressed mood, sleep disturbance, fatigue, appetite change, guilt/worthlessness, concentration difficulty, psychomotor change, and suicidal ideation. Scores index symptom burden rather than categorical diagnosis.
Generalized Anxiety Severity
As operationalized in the GAD-7 (Spitzer, Kroenke, Williams & Löwe, 2006), anxiety severity is assessed by the frequency of seven core symptoms of Generalized Anxiety Disorder specified in DSM-IV: nervousness, uncontrollable worry, excessive worry, restlessness, difficulty relaxing, irritability, and fearfulness.
Somatic Symptom Severity
As operationalized in the PHQ-15 (Kroenke, Spitzer & Williams, 2002), somatic symptom severity is assessed by the frequency and bothersomeness of 15 common physical symptoms (headaches, pain, gastrointestinal, cardiovascular, etc.) that account for more than half of all outpatient visits and are often associated with functional impairment.
เครื่องมือ
- Patient Health Questionnaire — 9 item(PHQ-9)Kroenke, K., Spitzer, R. L., & Williams, J. B. W.2001
- Patient Health Questionnaire — 15 item (Somatic Symptom Severity)(PHQ-15)Kroenke, K., Spitzer, R. L., & Williams, J. B. W.2002
- Patient Health Questionnaire — 2 item(PHQ-2)Kroenke, K., Spitzer, R. L., & Williams, J. B. W.2003
- Generalized Anxiety Disorder 7-item scale(GAD-7)Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B.2006
แบบทดสอบที่สร้างบนทฤษฎีนี้
PHQ-9: Patient Health Questionnaire (Depression)
9-item depression severity screener based on DSM criteria.
เรียนรู้เพิ่มเติม →PHQ-2: Ultra-Brief Depression Screener
Ultra-brief 2-item depression screening for depressed mood and anhedonia.
เรียนรู้เพิ่มเติม →GAD-7: Generalized Anxiety Disorder Scale
7-item anxiety severity screener for generalized anxiety disorder.
เรียนรู้เพิ่มเติม →PHQ-15: Somatic Symptom Severity Scale
15-item somatic symptom severity screening for physical complaints linked to distress.
เรียนรู้เพิ่มเติม →การประยุกต์ใช้เชิงปฏิบัติ
The PHQ-9 is used for depression screening in primary care, for severity grading, and for tracking response to treatment over time, which is its most valuable and least appreciated function. The PHQ-2 serves as a first-stage filter in high-volume settings. Score bands map to severity categories that inform stepped-care decisions. Outside clinical settings, the appropriate use is entirely self-referential: a score indicates whether a conversation with a clinician is warranted, and carries no diagnostic meaning on its own.
วิธีการวัดผล
Self-administered symptom-frequency items over a two-week window, summed to a total with published severity bands; sensitivity and specificity are cutoff-dependent and population-dependent.
ข้อวิจารณ์และข้อจำกัด
The conventional cutoff of 10 was derived in populations with relatively high depression prevalence; applied for universal screening in low-prevalence settings, it produces a majority of false positives, which is the core of the argument against untargeted screening. Levis and colleagues' individual-participant meta-analysis showed that cutoff-based estimates in the literature had been systematically inflated by selective reporting. Somatic items overlap with physical illness, inflating scores in medically ill populations. The PHQ-9 also compresses nine heterogeneous symptoms into one number, so identical totals can describe very different clinical pictures.
ผลงานตีพิมพ์สำคัญ
- Spitzer, R. L., Kroenke, K. & Williams, J. B. W.. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. 10.1001/jama.282.18.1737
- Kroenke, K., Spitzer, R. L. & Williams, J. B. W.. (2001). The PHQ-9: Validity of a brief depression severity measure. 10.1046/j.1525-1497.2001.016009606.x
- Levis, B., Benedetti, A. & Thombs, B. D.. (2019). Accuracy of the PHQ-9 for screening to detect major depression: Individual participant data meta-analysis. 10.1136/bmj.l1476