背景:重度抑郁症,焦虑症,创伤后应激障碍(PTSD)是青年成瘾治疗中最常见的合并症。因此,这些内在化障碍的筛查应该是物质使用障碍治疗摄入时标准常规的一部分.我们调查了抑郁症的有用性,焦虑和压力量表(DASS-21)作为这一目的的筛选器。
方法:一项具有全国代表性的样本,包括421名16-22岁患有主要大麻的寻求治疗的年轻人,酒精,可卡因,或苯丙胺使用障碍参与研究。在摄入时,我们进行了DASS-21和迷你国际神经精神病学访谈(MINI;Sheehan等人。,1998)根据精神疾病诊断和统计手册,第五版(DSM-5),作为“黄金标准”,“作为对转型中青年研究更广泛的基线评估的一部分[Moska等人。BMC精神病学。2021年;21(1):1-11]。
结果:在可比灵敏度(0.80-0.84)下,基于最优截止值,DASS-21总分检测任何DSM-5内化障碍(0.62)的特异性高于专门检测抑郁症的DASS分量表,焦虑,或PTSD(分别为0.44、0.49和0.51)。受试者工作特征曲线分析显示,DASS总分的曲线下面积(AUC)值为0.80,以检测任何内在化障碍(“良好区分”),与0.70-0.75的DASS抑郁和焦虑分量表的AUC值比较,以检测DSM-5抑郁,焦虑,和创伤后应激障碍(“公平歧视”)。检测任何内化障碍的最佳DASS总分截止值≥44导致0.81灵敏度,0.62特异性,0.80阳性预测值,和0.64阴性预测值。
结论:鉴于青少年成瘾护理中合并症内化障碍的高患病率,需要在治疗中解决这些合并症,以及DASS检测这些疾病的良好准确性,我们建议在荷兰的青少年成瘾治疗中实施DASS-21作为常规筛选器。
BACKGROUND: Major depression, anxiety disorders, and post-traumatic stress disorder (PTSD) are among the most prevalent comorbid mental disorders in youth addiction treatment. Hence, screening for these internalizing disorders should be part of the standard routine at intake in substance use disorder treatment. We investigated the usefulness of the Depression, Anxiety and Stress Scale (DASS-21) as a screener for this purpose.
METHODS: A nationally representative sample of 421 treatment-seeking youths aged 16-22 years with a primary cannabis, alcohol, cocaine, or amphetamine use disorder participated in the study. At intake, we administered the DASS-21 and the Mini International Neuropsychiatric Interview (MINI; Sheehan et al., 1998) based on the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), as \"gold standard,\" as part of a broader baseline assessment of the Youth in transition study [Moska et al. BMC Psychiatry. 2021;21(1):1-11].
RESULTS: At comparable sensitivity (0.80-0.84), based on the optimal cut-off value, specificity was higher for the DASS-21 total score detecting any DSM-5 internalizing disorder (0.62) than for the DASS subscales specifically detecting depression, anxiety, or PTSD (0.44, 0.49, and 0.51, respectively). Receiver operating characteristic curve analyses showed an area under the curve (AUC) value of 0.80 for the DASS total score to detect any internalizing disorder (\"good discrimination\"), compared with AUC values of 0.70-0.75 of the DASS depression and anxiety subscales to detect DSM-5 depression, anxiety, and PTSD (\"fair discrimination\"). The optimal DASS total score cut-off value of ≥44 for detecting any internalizing disorder resulted in 0.81 sensitivity, 0.62 specificity, 0.80 positive predictive value, and 0.64 negative predictive value.
CONCLUSIONS: Given the high prevalence of comorbid internalizing disorders in youth addiction care, the need to address these comorbid disorders in treatment, and the favorable accuracy of the DASS to detect these disorders, we recommend to implement the DASS-21 as routine screener in youth addiction treatment in the Netherlands.