DETECTION OF ANXIETY DISORDERS IN PRIMARY CARE: A META-ANALYSIS OF ASSISTED AND UNASSISTED DIAGNOSES.

Autor: Olariu E; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain., Forero CG; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain., Castro-Rodriguez JI; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain., Rodrigo-Calvo MT; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain., Álvarez P; Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain., Martín-López LM; Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain., Sánchez-Toto A; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain., Adroher ND; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain., Blasco-Cubedo MJ; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain., Vilagut G; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain., Fullana MA; Institut de Neuropsiquiatria i Addiccions (INAD), Parc Salut Mar, Barcelona, Spain., Alonso J; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.; Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain.
Jazyk: angličtina
Zdroj: Depression and anxiety [Depress Anxiety] 2015 Jul; Vol. 32 (7), pp. 471-84. Date of Electronic Publication: 2015 Mar 31.
DOI: 10.1002/da.22360
Abstrakt: Background: Evidence suggests that general practitioners (GPs) fail to diagnose up to half of common mental disorder cases. Yet no previous research has systematically summarized the evidence in the case of anxiety disorders. The aim of this review was to systematically assess and meta-analyze the diagnostic accuracy of GPs' assisted (i.e., using severity scales/diagnostic instruments) and unassisted (without such tools) diagnoses of anxiety disorders.
Methods: Systematic review (PROSPERO registry CRD42013006736) was conducted. Embase, Ovid Journals--Ovid SP Medline, Pubmed, PsycINFO, Scopus, Web of Science, and Science Direct were searched from January 1980 through June 2014. Seven investigators, working in pairs, evaluated studies for eligibility. The quality of included studies was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2). The main outcome measures were sensitivity and specificity of clinical diagnoses of any anxiety disorder. We pooled sensitivity and specificity levels from included studies using bivariate meta-analyses.
Results: Twenty-four studies were included in the meta-analysis with a total sample of 34,902 patients. Pooled sensitivity and specificity were estimated at 44.5% (95% CI 33.7-55.9%) and 90.8% (95% CI 87-93.5%). GPs' sensitivity was higher when diagnoses were assisted (63.6%, 95% CI 50.3-75.1%) than when unassisted (30.5%, 95% CI 20.7-42.5%) to the expense of some specificity loss (87.9%, 95% CI 81.3-92.4% vs. 91.4%, 95% CI 86.6-94.6%, respectively). Identification rates remained constant over time (P-value = .998).
Conclusions: The use of diagnostic tools might improve detection of anxiety disorders in "primary care."
(© 2015 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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