超简抑郁焦虑筛查量表在社区门诊的信度和效度研究

内科理论与实践››2021,Vol. 16››Issue (02): 116-120.doi:10.16138/j.1673-6087.2021.02.010

超简抑郁焦虑筛查量表在社区门诊的信度和效度研究

钱洁^1a, 姜敏敏², 陈晨³, 陈玉娇³, 于德华^1b(), 李春波⁴^,⁵()

1.上海市杨浦区中心医院（同济大学附属杨浦医院）a. 临床心理科;b. 全科医学科,上海 200090
2.上海市杨浦区长海社区卫生服务中心,上海 200433
3.上海市静安区江宁路街道社区卫生服务中心,上海 200040
4.开云网页登录医学院附属精神卫生中心,上海 200030
5.开云网页登录心理与行为开云足球app官方下载安装院,上海 200030

收稿日期:2020-12-25出版日期:2021-04-25发布日期:2022-07-26
通讯作者:于德华,李春波 E-mail:ydh1404@sina.com;licb@smhc.org.cn
基金资助:
国家重点研发计划(2018YFC2001605);上海市领军人才计划(YDH-20170627);上海市卫生健康委员会科研课题计划(20194Y0027);上海市科学技术委员会科研计划项目(19MC1911100)

Reliability and validity of the ultra-brief screening scale for depression and anxiety in outpatients clinics of community healthcare centers

QIAN Jie^1a, JIANG Minmin², CHEN Chen³, CHEN Yujiao³, YU Dehua^1b(), LI Chunbo⁴^,⁵()

1a. Department of Clinical Psychology;b. Department of General Practice, Shanghai Yangpu District Central Hospital, Tongji University School of Medicine, Shanghai 200090, China
2. Shanghai Yangpu District Changhai Community Health Service Center, Shanghai 200433, China
3. Shanghai Jing’an District Jiangning Road Community Health Service Center, Shanghai 200040, China
4. Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
5. Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai 200030, China

Received:2020-12-25Online:2021-04-25Published:2022-07-26
Contact:YU Dehua,LI Chunbo E-mail:ydh1404@sina.com;licb@smhc.org.cn

摘要/Abstract

摘要：

目的：初步探讨中文版超简抑郁焦虑筛查量表[4条目患者健康问卷（patient health questionnaire 4,PHQ-4）]在社区门诊患者中的信度与效度。方法：在上海2家社区卫生服务中心门诊随机抽取313例患者,由1名精神科主治医师和经过培训的2名全科医师,使用规定指导语帮助患者完成PHQ-4自评,并进行汉密尔顿抑郁量表（Hamilton depression scale,HAMD）和汉密尔顿焦虑量表（Hamilton anxiety scale,HAMA）评定,最后采用国际神经精神科简式访谈问卷进行访谈。初次评定后7~14 d内,随机抽取其中50例患者进行PHQ-4重测。对PHQ-4的内在一致性信度、重测信度、效标效度和结构效度等进行计算分析;并进行受试者工作特征曲线（receiver operating characteristic curve, ROC曲线）分析确定最佳分界值,计算灵敏度、特异度等。结果：PHQ-4的内在一致性信度克龙巴赫α系数（Cronbach’α系数）为0.833, 折半信度的Spearman-Brown系数为0.835。重测信度计算组内相关系数（intraclass correlation coefficient,ICC）为0.969。PHQ-4总分与HAMD、HAMA总分的相关系数分别为0.391和0.407,差异均具有统计学意义（P<0.01）。ROC分析得出曲线下面积（area under curve,AUC）为0.919,最佳分界值为3分。PHQ-4的灵敏度和特异度分别为87.1%和82.6%。结论：中文版PHQ-4在社区门诊患者中具有较好的信度和效度,适合抑郁、焦虑的筛查。

关键词:超简抑郁焦虑筛查量表,患者健康问卷,信度,效度,社区门诊

Abstract:

ObjectiveTo preliminary evaluate the reliability and validity of the ultra-brief screening scale for depression and anxiety [patient health questionnaire 4 (PHQ-4)] in outpatients clinics of community healthcare centers.MethodsTotally 313 patients were randomly selected from two community healthcare centers in Shanghai. The patients were asked to complete the PHQ-4 following the prescribed instruction with assistance of a psychiatrist and two physicians, and then were evaluated according Hamilton depression scale(HAMD) and the Hamilton anxiety scale(HAMA) followed by a mini international neuropsychiatric interview(MINI). Out of subjects screened, 50 patients were randomly selected to retest the PHQ-4. The reliability coefficients, retest reliability and criterion validity sensitivity and specificity were calculated. The receiver operating characteristic(ROC) analysis was performed to determine the best cut-off value, and the sensitivity and specificity accordingly.ResultsThe Cronbach’α coefficient of PHQ-4 was 0.833, the Spearman-Brown coefficient of the split-half reliability was 0.835. For the test-retest reliability, the intraclass correlation coefficient (ICC) was 0.969. The correlation coefficients of generalized anxiety disorder 7(GAD-7) with HAMD and HAMA were 0.391 and 0.407 respectively, both statistically significant (P<0.01). ROC analysis showed that the area under curve(AUC) was 0.919, and the best cut-off value was 3, the sensitivity and specificity of PHQ-4 were 87.1% and 82.6% respectively.ConclusionsThe Chinese version of the PHQ-4 maintains high reliability and validity in outpatient clinics of community healthcare centers, and is suitable for the screening of depression and anxiety.

Key words:The ultra-brief screening scale for depression and anxiety,Patient health questionnaire 4,Reliability,Validity,Community healthcare center outpatients

中图分类号:

R749.7

钱洁, 姜敏敏, 陈晨, 陈玉娇, 于德华, 李春波. 超简抑郁焦虑筛查量表在社区门诊的信度和效度研究[J]. 内科理论与实践, 2021, 16(02): 116-120.

QIAN Jie, JIANG Minmin, CHEN Chen, CHEN Yujiao, YU Dehua, LI Chunbo. Reliability and validity of the ultra-brief screening scale for depression and anxiety in outpatients clinics of community healthcare centers[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(02): 116-120.

图/表4

类别	性别		年龄（岁）		婚姻状况		文化程度
例数[n（%）]	117(37.4)	196(62.6)	60(19.2)	103(32.9)	146(46.6)	4(1.3)	275(87.9)	34(10.9)	4(1.3)	103(32.9)	98(31.3)	105(33.5)	7(2.2)
PHQ-4（分）	1.38±1.85	1.34±1.93	0.72±1.22	1.27±1.89	1.71±2.07	-	1.28±1.74	2.03±2.82	-	1.46±2.26	1.83±1.83	0.89±1.46	-

表1

图1

PHQ-4	MINI	总计
阳性	27	49	76
阴性	4	233	237
总计	31	282	313

表2

PHQ-4	条目1	条目2	条目3	条目4	PHQ-2总分	GAD-2总分	PHQ-4总分
条目1	1.000
条目2	0.600	1.000
条目3	0.505	0.669	1.000
条目4	0.547	0.562	0.566	1.000
PHQ-2总分	0.907	0.880	0.650	0.619	1.000
GAD-2总分	0.586	0.704	0.929	0.831	0.717	1.000
PHQ-4总分	0.823	0.864	0.837	0.770	0.941	0.910	1.000

表3

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