VALIDASI KLINIK GENERAL HEALTH QUESTIONNAIRE-12 SEBAGAI INSTRUMEN SKRINING GANGGUAN SOMATOFORM DI PUSKESMAS

Salma, Rahmat Hidayat, M.Sc., Ph.D.

2013 | Tesis | S2 Magister Profesi Psikologi

Gangguan somatoform merupakan salah satu gangguan yang banyak dijumpai pada pasien yang datang ke layanan kesehatan primer, termasuk di Pusat Kesehatan Masyarakat (Puskesmas). Sayangnya skrining pasien dengan kemungkinan diagnosis gangguan somatoform di Indonesia masih terkendala belum adanya instrumen skrining yang valid, reliabel serta memiliki tingkat sensitivitas dan spesifisitas tinggi. Penelitian ini bertujuan untuk menguji validitas klinik GHQ-12, melalui Structured Clinical Interview for DSM IV Disorder-Axis I (SCID-I), sebagai baku emas, sehingga dapat digunakan sebagai instrumen skrining gangguan somatoform pada pasien Puskesmas. Penelitian ini melibatkan 250 sampel pasien dari 11 Puskesmas di Kabupaten Sleman dan Kota Yogyakarta. Dari 215 data pasien yang dapat dianalisis, sebanyak 57 orang (26,5%) pasien terdiagnosis Gangguan Somatoform. Koefisien reliabilitas Alpha Cronbach tampak memuaskan berdasarkan metode skoring bimodal, Likert, maupun c-GHQ (0,863; 0,893; dan 0,854 secara berturut-turut). Principal Component Analysis (PCA) menghasilkan dua komponen pembentuk GHQ-12, yaitu “distress psikologis” dan “disfungsi sosial”. Analisis Receiving Operating Curve (ROC) menunjukkan Area Under the Curve (AUC) berkisar antara 65,1-66,6%. Hasil penelitian ini menunjukkan GHQ-12 dapat digunakan sebagai instrumen skrining Gangguan Somatoform di Puskesmas dengan kehati-hatian. Titilk potong yang direkomendasikan adalah >5 dengan metode skoring c-GHQ. Sejumlah pertimbangan didiskusikan untuk implementasi GHQ-12 lebih lanjut.

Somatoform disorder is one of the high prevalent mental health problems and one that is common among patients of Primary Care, including Pusat Kesehatan Masyarakat (Puskesmas). However, there is no valid, reliable, sensitive, and specific screening instrument available in Primary Care to detect somatoform disorder in Indonesia. This study aimed to examine clinical validity of GHQ-12 through Structured Clinical Interview for DSM IV Disorder-Axis I (SCID-I) as a gold standard and consider GHQ-12 as screening instrument of somatoform disorder in Primary Care setting. Data of 250 patients from 11 Primary Care institutions in Sleman and Kota Yogyakarta District were collected as sample. Of the 215 complete data of patients, there were 57 (26.51%) patients diagnosed by Somatoform Disorders (SDs).The Alpha Cronbach Reliability coefficient were satisfactory according to bimodal, Likert, and c-GHQ scoring methods (0.863, 0.893, and 0.854 respectively). Principal Component Analysis (PCA) yielded two components of GHQ-12, namely “psychological distress” and “social dysfunction”. Receiver Operating Curve (ROC) analysis applied and revealed Area Under the Curve (AUC) between 65.1-66.6% for three different scoring method. The optimum cut-off score was >5 using Likert scoring method with a sensitivity of 73.7% and a specificity of 54.4%. LR+ and LR- were 1.62 and 0.48 respectively. The result of this study shows that GHQ-12 can be used with caution as screening instrument of SDs in Primary Care. Further implementation is discussed.

Kata Kunci : validasi klinik, skrining, GHQ-12, gangguan somatoform