几种焦虑症状筛查量表信度和效度的比较-钱洁

JInternMedConceptsPract2011,Vol.6,No.3（anxietydisorder）（generalizedanxietydisorder,GAD）（panicdisorder,PD）[1]，，[2]。，、。、（hospital··1，2a，2b，2b，1（1.，200030；2.a.；b.，200065）[]：。：、、，、、7、2、，。300。50（35），7~14d。。：Cronbachα0.796～0.932，0.820～0.906。，12，，9。75%，60%；85%。（ROC）0.869～0.963，，2。：，，，。：；；；：R749.72：A：1673-6087（2011）03-0176-04ComparativestudyofreliabilityandvaliditybetweenseveralscreeningscalesforanxietyQIANJie1,BIANCui-dong2a,CUIHai-song2b,WUWen-yuan2b,LIChun-bo1.1.DepartmentofPsychiatry,ShanghaiMentalHealthCenter,ShanghaiJiaotongUniversitySchoolofMedicine,Shanghai200030,China;2.a.DepartmentofUrinarySurgery;b.DepartmentofPsychiatry,ShanghaiTongjiHospital,Shanghai200065,China[Abstract]ObjectiveTocomparethereliabilityandvalidityofseveralanxietyscreeningscales.MethodsThepatientsenrolledforanxietyscreeningwererandomlyselectedasacertainproportionfromoutpatientdepartmentsofinternalmedicine,surgeryandgynecologyofatertiarygeneralhospital.Thepatientswereaskedtocomplete6questionairescales:theanxietyscale,the7-itemgeneralizedanxietydisorderscale(GAD-7)，2-itemgeneralizedanxietydisorderscale(GAD-2),hospitalanxietyanddepressionscale（HAD）,andtheanxietysyndromepartofthepatienthealthquestionaire(PHQ).Structuredinterviewswerethentakenaccordingtotheminiinternationalneuropsychiatricinterview(MINI).Threehundreadsvalidsampleswerecollected.Fiftypatients(35ofwhichwerevalid)ofthe300werechosenrandomlyfortest-retestwithin7to14daysafterthefirstinterview.Datawerecollectedandanalyzedforcalculationandthencomparedthereliabilityandvalidityofthe6scales.ResultsCronbach’αcoefficientsofthe6scaleswerebetween0.796and0.932,andthetest-retestreliabilitywasbetween0.820and0.906.HADhadthehighestpositivenumber(12),andtheanxietysyndromepartofPHQdidtheleastpositivenumber(9).Thehighestsensitivitywas75%intheHAD,asotherswerearound60%.Specificityofthe6scaleswereallabove85%.Theareasunderrelativeoperatingcharacteristic(ROC)curveswerebetween0.869and0.963,withthelargestintheanxietysyndromepartofthePHQandthesmallestinGAD-2.ConclusionsTheanxietyscale,GAD-2,GAD-7,HAD,andtheanxietysyndromepartofthePHQhadgoodreliabilityandvalidity,andeachofthemhadtheirownadvantages.Theyallhadacertainvalueinthescreeningofanxietysymptom.Keywords:Generalhospital;Anxietysymptom;Screening;Scalescore：（：2007CB512306）；(：2008AA02Z412);（：30770773，81071098）；(：074119520)：E-mail:[e-mail]176··201163anxietyanddepressionscale，HAD）、7GAD（GAD-7）、2GAD（GAD-2）（patienthealthquestionnaire，PHQ）。，。、2009920103，（、、、、）、（、、）。≥18，，，。。、、HAD、GAD-7、GAD-2、PHQ5。，9，“”“”，“”1，5，50%，，。82％[3-4]。HAD，[5]。14，7HAD。0~34。0~7；8~10；11~21[6]。PHQSpitzer[7]4（DSM-），、、、。，，、，[8]。GAD-7，GAD[9]。7，0~34。5、10、15、、。10，89%，82%[9]。，85%[8]。GAD-2GAD-72，0~6。3，GAD，86%83%，PD、、[7]。PHQ5，7，4，PHQ。（theminiinternationalneuropsychiatricinterview,MINI）“”。MINIDSM--IR（SCID-）（CIDI），κ0.7[11-12]。[13]，91.2%，96.3%。SCID-P，κ0.764。、、。300，，。5，，60，。，30050，7~14d。（ROC），ROC（areaundercurve，AUC）。、SPSS16.0。、、、χ2。、404，96（23.8%），8（2.0%），300。、、。300，50，，35。GAD16，5.3%，PD3，1.0%。PD10，3.3%。PDGAD，216（5.3%）。、Cronbachα，Kendallτ-b。5（1）。177··JInternMedConceptsPract2011,Vol.6,No.3、HAD、，Kendallτ-b，HAD、（2）。MINI“”，HAD、、GAD-2、GAD-78、5、3、8，PHQ，GAD12、11、10、10、9。HAD，85%。GAD-2、GAD-7、PHQ（LR+），10。（NPV），95%。κ0.258~0.538（3）。AUC0.8，PHQ（4）。。、、[3-4,6-8,14-20]。、Cronbachα0.8，0.6～0.8，0.6[21]。5CronbachαGAD-20.796，0.8，。，，Kendallτ-b[22]。，0.70，5Kendallτ-b0.820～0.883，。Spitzer[6]、Garcia-Campayo[23]。5。、HAD，4HAD。，，。0.4～0.8。4HAD0.5，4HAD。MINI，GAD。，，，。，HAD，，。PHQ，，。HAD，，“”“”，，。GAD-25，2，，，；GAD-7，，。ROC1－，，AUC，AUC。AUC＜0.7，0.7～0.9，＞0.9[22]。，PHQAUC，GAD-7HAD0.9。，3AUCP95%0.8920.0320.0000.829～0.956GAD-20.8690.0560.0000.760～0.979GAD-70.9170.0260.0000.866～0.967HAD0.9250.0250.0000.877～0.973PHQ0.9630.0160.0000.933～0.993HAD0.9290.0250.0000.881～0.9784AUC（%）（%）LR+LR－PPV（%）NPV（%）κ68.885.24.6450.36720.898.00.258GAD-262.594.411.100.39738.597.80.439GAD-762.594.711.790.39640.097.80.452PHQ56.397.522.870.44856.397.50.538HAD75.086.65.6050.28924.098.40.3083、、LRκLR－：；PPV：GAD-2GAD-7PHQHADCronbachα0.8310.7960.8800.9000.851Kendallτ-b0.8201）0.8431）0.8521）0.8711）0.8831）1CronbachαKendallτ-b1）：P＜0.01（）GAD-2GAD-7PHQHAD0.4441）0.4061）0.4501）0.4971）HAD0.4971）0.4691）0.5081）0.5211）2HAD、1）：P＜0.01（）178··201163GAD-2。AUC，，，。，、GAD-2、GAD-7、HAD、PHQ，，，，，。[][1].[M].3.：，2001：105.[2]DemyttenaereK,BruffaertsR,Posada-VillaJ,etal.Prevalence,severity,andunmetneedfortreatmentofmentaldisordersintheWorldHealthOrganizationWorldMentalHealthSurveys[J].JAMA,2004,291(21):2581-2590.[3]GoldbergD,BridgesK,Duncan-JonesP,etal．Detectinganxietyanddepressioningeneralmedicalsettings[J].BMJ,1988,297(6653):897-899.[4]ArikianSR,GormanJM.Areviewofthediagnosis,pharmacologictreatment,andeconomicaspectsofanxietydisorders[J].PrimCareCompanionJClinPsychiatry,2001,3(3):110-117.[5].“”[J]．，1993，2(3)：17-19.[6]BarczakP,KaneN,AndrewsS,etal.Patternsofpsychiatricmorbidityinagenito-urinaryclinic.Avalidationofthehospitalanxietydepressionscale(HAD)[J].BrJPsychiatry,1988,152(5):698-700.[7]SpitzerRL,KroenkeK,WilliamsJB.Validationandutilityofaself-reportversionofPRIME-MD:thePHQprimarycarestudy.PrimaryCareE