超简抑郁焦虑筛查量表在社区门诊的信度和效度研究

doi:10.16138/j.1673-6087.2021.02.010

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.上海交通大学医学院附属精神卫生中心,上海 200030
5.上海交通大学心理与行为科学研究院,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:2020-12-25 Online:2021-04-25 Published: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:

Objective To 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. Methods Totally 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. Results The 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. Conclusions The 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

表1

图1

表2

表3

参考文献 24

[1]	Mergl R, Seidscheck I, Allgaier AK, et al. Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition[J]. Depress Anxiety, 2010, 24(3): 185-195. doi: 10.1002/da.20192 URL
[2]	李清伟, 陆峥. 重视综合医院和社区卫生医疗机构对焦虑障碍与抑郁障碍的识别和防治[J]. 中华全科医师杂志, 2016, 15(5): 321-324.
[3]	Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study[J]. Lancet Psychiatry, 2019, 6(3): 211-224. doi: 10.1016/S2215-0366(18)30511-X URL
[4]	Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society[J]. Depress Anxiety, 2010, 16(4): 162-171. doi: 10.1002/da.10065 URL
[5]	吴秋霞, 陈淑宝, 罗小阳, 等. 综合医院非精神科医师对广泛性焦虑障碍的知晓情况调查[J]. 中国临床心理学杂志, 2016, 24(5): 894-899.
[6]	李旭, 白文佩, 廖秦平, 等. 妇科门诊就诊者的抑郁症或(和)焦虑症患病率及妇科医生识别状况调查[J]. 中国全科医学, 2009, 12(23): 2144-2147.
[7]	王威. 沈阳市综合医院内科门诊焦虑障碍患病率与医生识别率现状调查[D]. 沈阳: 中国医科大学, 2007.
[8]	Zhang H, Yu D, Wang Z, et al. What impedes general practitioners’ identification of mental disorders at outpatient departments[J]?. Ann Glob Health, 2019, 85(1): 134.
[9]	Spitzer RL, Kroenke K, Williams JB, et al. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study[J]. JAMA, 1999, 282(18): 1737-1744. doi: 10.1001/jama.282.18.1737 URL
[10]	Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613. doi: 10.1046/j.1525-1497.2001.016009606.x pmid: 11556941
[11]	卞崔冬, 何筱衍, 钱洁, 等. 患者健康问卷抑郁症状群量表在综合性医院中的应用研究[J]. 同济大学学报(医学版), 2009, 30(5): 136-140.
[12]	Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7[J]. Arch Intern Med, 2006, 166(10): 1092-1097. doi: 10.1001/archinte.166.10.1092 pmid: 16717171
[13]	何筱衍, 李春波, 钱洁, 等. 广泛性焦虑量表在综合性医院的信度和效度研究[J]. 上海精神医学, 2010, 22(4): 200-203.
[14]	Löwe B, Wahl I, Rose M, et al. A 4-item measure of depression and anxiety: validation and standardization of the patient health questionnaire-4 (PHQ-4) in the general population[J]. J Affect Disord, 2010, 122(1-2): 86-95. doi: 10.1016/j.jad.2009.06.019 URL
[15]	Khubchandani J, Brey R, Kotecki J, et al. The psychometric properties of PHQ-4 depression and anxiety screening scale among college students[J]. Arch Psychiatr Nurs, 2016, 30(4): 457-462. doi: 10.1016/j.apnu.2016.01.014 URL
[16]	Rodríguez-Muñoz MF, Ruiz-Segovia N, Soto-Balbuena C, et al. The psychometric properties of the patient health questionnaire-4 for pregnant women[J]. Int J Environ Res Public Health, 2020, 17(20): 7583. doi: 10.3390/ijerph17207583 URL
[17]	Materu J, Kuringe E, Nyato D, et al. The psychometric properties of PHQ-4 anxiety and depression screening scale among out of school adolescent girls and young women in Tanzania: a cross-sectional study[J]. BMC psychiatry, 2020, 20(1): 321. doi: 10.1186/s12888-020-02735-5 URL
[18]	Ghaheri A, Omani-Samani R, Sepidarkish M, et al. The four-item patient health questionnaire for anxiety and depression: a validation study in infertile patients[J]. Int J Fertil Steril, 2020, 14(3): 234-239. doi: 10.22074/ijfs.2020.44412 pmid: 33098392
[19]	Cano-Vindel A, Muñoz-Navarro R, et al. A computerized version of the patient health questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care[J]. J Affect Disord, 2018, 234: 247-255. doi: 10.1016/j.jad.2018.01.030 URL
[20]	Kroenke K, Spitzer RL, Williams JB, et al. An ultra-brief screening scale for anxiety and depression: the PHQ-4[J]. Psychosomatics, 2009, 50(6): 613-621. doi: 10.1176/appi.psy.50.6.613 pmid: 19996233
[21]	Lecrubier Y, Sheehan DV, Weiller E, et al. The mini international neuropsychiatric interview (MINI)[J]. Eur Psychiatry, 1997, 12(5): 224-231. doi: 10.1016/S0924-9338(97)83296-8 URL
[22]	Sheehan DV, Lecrubier Y, Sheehan KH, et al. The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability[J]. Eur Psychiatry, 1997, 12(5): 232-241. doi: 10.1016/S0924-9338(97)83297-X URL
[23]	司天梅, 舒良, 党卫民, 等. 简明国际神经精神访谈中文版的临床信效度[J]. 中国心理卫生杂志, 2009, 23(7): 30-36.
[24]	郭起浩, 黄琳. 我国临床神经心理测验的机遇、挑战与展望[J]. 内科理论与实践, 2020, 15(3): 137-140.

类别	性别		年龄（岁）				婚姻状况			文化程度
类别	男性	女性	<60	60~69	≥70	缺失	在婚	未婚丧离	缺失	初中及以下	高中	大学及以上	缺失
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	-

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

超简抑郁焦虑筛查量表在社区门诊的信度和效度研究

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

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 24

相关文章 15

编辑推荐

Metrics

本文评价

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

[1]	张鑫, 谈敏佳. 一种新的证据冲突识别与调整方法[J]. 上海交通大学学报, 2022, 56(8): 1043-1050.
[2]	邹绍艳, 范劲松. 评分员视角下外语写作测试分项评分标准的界定[J]. 当代外语研究, 2022, 22(4): 133-143.
[3]	郑德重, 杨媛媛, 黄浩哲, 谢哲, 李文涛. 基于距离置信度分数的多模态融合分类网络[J]. 上海交通大学学报, 2022, 56(1): 89-100.
[4]	许皖栋, 辜向东. 认知效度理据、概念、模型及实证研究综述[J]. 当代外语研究, 2020, 20(6): 68-78.
[5]	陈璇, 李奇, 李博文, 肖意可, 晏良. 基于多源数据可信度的制导精度融合评估[J]. 空天防御, 2020, 3(4): 14-20.
[6]	陈岩, 李艳艳, 杨立波, 倪兴虎, 杨柏胜, 王亚辉. 地海杂波统计特性研究概述[J]. 空天防御, 2020, 3(4): 44-51.
[7]	李奇, 李凡, 唐善军, 王丙乾, 张励. 红外导引头抗干扰性能仿真试验与评估技术研究[J]. 空天防御, 2020, 3(4): 127-133.
[8]	黄莹, 卞薇薇. 颈部严重瘢痕青少年患者心理弹性评估工具的编制与评价[J]. 组织工程与重建外科杂志, 2020, 16(3): 245-249.
[9]	刘勇, 阳贵兵. 作战仿真系统可信度评估研究[J]. 空天防御, 2019, 2(2): 49-52.
[10]	常新萍, 朱长泉. 语篇语法测量:效度及教学导向[J]. 当代外语研究, 2017, 17(05): 16-20.
[11]	范劲松. Rasch模型下自我评估量表的效度探析[J]. 当代外语研究, 2017, 17(02): 34-40.
[12]	王露芳. 在线写作自动评改系统在高职英语写作教学中的反馈效度研究[J]. 当代外语研究, 2016, 16(01): 53-56.
[13]	席小明, 李清华. 当代语言测试理论与实践——席小明博士访谈录[J]. 当代外语研究, 2015, 15(08): 26-30.
[14]	李艳峰，王新晴，张梅军，朱会杰. 基于奇异值分解和深度信度网络多分类器的滚动轴承故障诊断方法[J]. 上海交通大学学报（自然版）, 2015, 49(05): 681-686.
[15]	陈征. 基于言据性的语篇可信性语用分析[J]. 当代外语研究, 2014, 14(04): 23-28.