SRAS-MD筛查危险行为的有效性研究
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摘要
目的研发用于精神障碍筛查与风险评估的筛查软件并检测其有效性。方法 2017年9—12月运用随机整群抽样法抽取1 883名入营应征青年,对其实施精神障碍筛查软件的受测者自评、知情者他评和计算机引导的半结构式访谈3部分软件测试。结果 (1)5类危险行为(自伤、伤人、破坏行为、私自出走、晕倒抽搐)及总危险行为与自评的阳性符合率为95.96%～98.61%,阴性符合率为80.14%～88.13%,总符合率为80.75%～89.14%;与他评的阳性符合率为33.33%～69.84%,阴性符合率为80.14%～88.13%,总符合率为91.62%～97.05%;与"自评+他评"的阳性符合率均为100.00%,阴性符合率为79.01%～87.34%,总符合率为79.77%～88.97%;自评、他评、"自评+他评"测试结果均与访谈有关联,且呈正相关(Φ=0.209～0.685,均P<0.05)。(2)自评与他评的阳性符合率、阴性符合率和总符合率分别为82.79%、81.98%和82.03%,自评与"自评+他评"的阳性符合率、阴性符合率和总符合率分别为94.94%、100.00%和98.79%,他评与"自评+他评"的阳性符合率、阴性符合率和总符合率分别为29.61%、100.00%和83.25%;前置条件测试结果之间均有关联,呈正相关(Φ=0.396～0.967,均P<0.05)。(3)城镇入营应征青年自伤、晕倒抽搐和总危险行为的发生率显著高于农村入营应征青年,差异均有统计学意义(χ~2=6.336、4.321、6.210,均P<0.05)。结论软件前置条件与判别条件设计合理,可以较准确的评估危险行为;在危险行为筛查中,应选自评+访谈、自评+他评+访谈两种模式之一,则能确保评估的准确性。
[Objective]To develop the Screening and Risk Assessment System for Mental Disorders(SRAS-MD) and test its effectiveness.[Methods]1 883 recruited male youth were collected by the random cluster sampling from September to December 2017,and they were assessed with SRAS-MD in three parts: subjects' self-assessment,others-ratings and computer-guided semi-structured interview.[Results]① For the five kinds of risk behaviors(self-injury,injury,destruction,running away,fainting and convulsion) and total risk behaviors,the positive,negative and total coincidence rates to self-assessment were 95.96%-98.61%,80.14%-88.13% and 80.75%-89.14%,respectively. The positive,negative and total coincidence rates to others-ratings were 33.33%-69.84%,80.14%-88.13%,91.62%-97.05%,respectively. The positive,negative and total coincidence rates to selfassessment+others-ratings were 100.00%,79.01%-87.34% and 79.77%-88.97%,respectively. The test results of self-assessment,others-ratings,and self-assessment+others-ratings were positively correlated with interviews(Φ=0.209-0.685,all P<0.05).② The positive,negative and total coincidence rates between self-assessment and others-ratings were 82.79%,81.98% and82.03%,respectively. The positive,negative and tota l coincidence rates between self-assessment and self-assessment+others-ratings were 94.94%,100.00% and 98.79%,respectively. The positive,negative and total coincidence rates between others-ratings and selfassessment+others-ratings were 29.61%,100.00% and 83.25%,respectively. There were positive correlations among preconditions(Φ=0.396-0.967,all P<0.05). ③The incidence rates of self-injury,fainting and convulsion and total risk behavior among urban recruited youth were higher than those among rural recruited youth(χ~2=6.336,4.321,6.210,all P<0.05).[Conclusion]The criterion and prec ondition design of software are rea sonable,which can accurately evaluate risk behavior. In the screening of risk behavior,one of the two modes,self-assessment+interview and self-assessment+others-ratings+interview,should be selected to ensure the accuracy of assessment.
[Objective]To develop the Screening and Risk Assessment System for Mental Disorders(SRAS-MD) and test its effectiveness.[Methods]1 883 recruited male youth were collected by the random cluster sampling from September to December 2017,and they were assessed with SRAS-MD in three parts: subjects' self-assessment,others-ratings and computer-guided semi-structured interview.[Results]① For the five kinds of risk behaviors(self-injury,injury,destruction,running away,fainting and convulsion) and total risk behaviors,the positive,negative and total coincidence rates to self-assessment were 95.96%-98.61%,80.14%-88.13% and 80.75%-89.14%,respectively. The positive,negative and total coincidence rates to others-ratings were 33.33%-69.84%,80.14%-88.13%,91.62%-97.05%,respectively. The positive,negative and total coincidence rates to selfassessment+others-ratings were 100.00%,79.01%-87.34% and 79.77%-88.97%,respectively. The test results of self-assessment,others-ratings,and self-assessment+others-ratings were positively correlated with interviews(Φ=0.209-0.685,all P<0.05).② The positive,negative and total coincidence rates between self-assessment and others-ratings were 82.79%,81.98% and82.03%,respectively. The positive,negative and tota l coincidence rates between self-assessment and self-assessment+others-ratings were 94.94%,100.00% and 98.79%,respectively. The positive,negative and total coincidence rates between others-ratings and selfassessment+others-ratings were 29.61%,100.00% and 83.25%,respectively. There were positive correlations among preconditions(Φ=0.396-0.967,all P<0.05). ③The incidence rates of self-injury,fainting and convulsion and total risk behavior among urban recruited youth were higher than those among rural recruited youth(χ~2=6.336,4.321,6.210,all P<0.05).[Conclusion]The criterion and prec ondition design of software are rea sonable,which can accurately evaluate risk behavior. In the screening of risk behavior,one of the two modes,self-assessment+interview and self-assessment+others-ratings+interview,should be selected to ensure the accuracy of assessment.
引文
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[19]孔令明,张理义,梅贵森,等.城市和农村军人适应不良情况及其影响因素调查与分析[J].人民军医,2012,55(11):1031-1033.
[20]王创.新兵适应障碍自评量表的初步修订及应用[D].南宁:广西医科大学,2015:18-25.
[21]王周然.新兵人格障碍诊断问卷(PDQ-4+)的信效度检验及应用[D].桂林:桂林医学院,2015:24-26.
[22]陈友庆,薛兴.人格诊断问卷在军人群体中的应用[J].中国健康心理学杂志,2012,20(9):1334-1337.
[23]赵汉清,过伟,沈嘉懿.心理危机评估与干预软件的研制与测试[J].解放军预防医学杂志,2015,33(2):151-153.
[24]张艳,于凯,欧阳晖,等.集训期新兵适应障碍与心理安全感的关系[J].中国健康心理学杂志,2017,25(11):1677-1682.
[25]李成吉.部队新兵心理评测系统分析与研究[D].大连:大连理工大学,2016:38-41.
[2]LERNER RM,GALAMBOS NL.Adolescent development:Challenges and opportunities for research,programs,and policies[J].Annu Rev Psychol,1998,49(1):423-446.
[3]王晓彦,周明娜,童俊.友谊质量与中职学生危险行为的关系[J].中国健康心理学杂志,2013,21(2):273-277.
[4]EATON DK,KANN L,KINCHEN S,et al.Youth risk behavior surveillance-United States,2011[J].MMWR Surveil Summ,2012,61(4):1-162.
[5]GADALLA TM.Unhealthy behaviours among Canadian adolescents:prevalence,trends and correlates[J].Chronic Dis Inj Can,2012,32(3):156-163.
[6]张微,江光荣,陈佳,等.555例危险行为高危青少年的心理干预:来自个体辅导和团体辅导的效果对照[J].心理科学,2014,37(1):225-231.
[7]汪微,刘伟立,张迪,等.某部新兵入伍适应期自杀意念的追踪研究[J].中国健康心理学杂志,2016,24(12):1796-1798.
[8]余小鸣,张译天,黄思哲,等.青少年意外伤害与健康危险行为的关联研究[J].中华行为医学与脑科学杂志,2017,26(2):163-166.
[9]封敏,储康康,徐斌,等.南京城区青少年攻击性行为及相关影响因素[J].中华行为医学与脑科学杂志,2016,25(11):1018-1022.
[10]周宏奎,陈海燕,李红政,等.不同风险决策行为新兵的人格特征[J].神经疾病与精神卫生,2015,15(2):140-143.
[11]李锐,苗丹民,杨业兵,等.应征青年入伍前后性格测验差异性[J].中国健康心理学杂志,2013,21(3):364-366.
[12]KELLEHER I,RAMSAY H,DEVYLDER J.Psychotic experiences and suicide attempt risk in common mental disorders and borderline personality disorder[J].Acta Psychiatr Scand,2017,135(3):212-218.
[13]MILLNER AJ,URSANO RJ,HWANG I,et al.Prior Mental Disorders and Lifetime Suicidal Behaviors Among US Army Soldiers in the Army Study to Assess Risk and Resilience in Servicemembers(Army STARRS)[J/OL].Suicide Life Threat Behav,2017:1-20.[2018-05-01].http://eng.ucdrs.superlib.net/0306.DOI:10.1111/sltb.12394
[14]赵兰民,甘景梨,杨春,等.2005年某部新兵适应障碍的调查分析[J].中国健康心理学杂志,2007,15(7):646-647.
[15]GOODWIN L,WESSELY S,HOTOPF M,et al.Are common mental disorders more prevalent in the UK serving military compared to the general working population[J].Psychol Med,2014,45(9):1881-1891.
[16]周林,甘景梨,徐东杰.某部235名新兵士兵职业基本适应性检测结果[J].中国健康心理学杂志,2017,25(9):1339-1342.
[17]李红政,陈海燕,王骞,等.新兵精神障碍筛查问卷的初步编制[J].神经疾病与精神卫生,2016,16(5):506-509.
[18]杨帆,王牮,童俊,等.青少年危险行为的聚类分析[J].中华行为医学与脑科学杂志,2014,23(7):636-638.
[19]孔令明,张理义,梅贵森,等.城市和农村军人适应不良情况及其影响因素调查与分析[J].人民军医,2012,55(11):1031-1033.
[20]王创.新兵适应障碍自评量表的初步修订及应用[D].南宁:广西医科大学,2015:18-25.
[21]王周然.新兵人格障碍诊断问卷(PDQ-4+)的信效度检验及应用[D].桂林:桂林医学院,2015:24-26.
[22]陈友庆,薛兴.人格诊断问卷在军人群体中的应用[J].中国健康心理学杂志,2012,20(9):1334-1337.
[23]赵汉清,过伟,沈嘉懿.心理危机评估与干预软件的研制与测试[J].解放军预防医学杂志,2015,33(2):151-153.
[24]张艳,于凯,欧阳晖,等.集训期新兵适应障碍与心理安全感的关系[J].中国健康心理学杂志,2017,25(11):1677-1682.
[25]李成吉.部队新兵心理评测系统分析与研究[D].大连:大连理工大学,2016:38-41.