综合医院神经症筛查量表的编制和初步应用
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摘要
目的将躯体症状、情感症状及负性事件三者结合,编制一份适合在综合医院实施的神经症筛查量表。方法 (1)通过查阅文献、参考CCMD-3、ICD-10神经症诊断标准,结合临床经验构建神经症量表三维度模型,编制躯体症状、负性情感、负性事件条目,并进行预调查条目分析,形成神经症筛查量表。(2)对461例患者进行一般人口学特点、神经症筛查量表、GAD-7、PHQ-9的调查及评测,精神科医师根据ICD-10诊断标准进行电话访谈诊断。(3)分析各人口学特点的得分情况,利用探索性因素分析验证量表的建构效度,利用ROC曲线分析选定量表的临界值,分析量表的内部信度及效标效度,分析量表3个维度之间的关系。结果综合医院神经症筛查量表(Neuro-11)包含11个条目,3个维度分别为躯体症状、负性情感及负性事件。当量表得分≥10分时,所对应的敏感度为0.88,特异度为0.72。Neuro-11的Cronbachα系数为0.73,分半信度系数为0.67;并且随着Neuro-11的得分越高,GAD-7、PHQ-9的得分越高。结论综合医院神经症筛查量表的三维理论合理,对神经症的诊断价值良好,具有良好的信度、效度,并且可作为神经症严重程度的衡量工具。
Objective To establish a brief self-report scale(Neuro-11) to identify probable neurotic patients along with somatic discomfort, negative emotional symptoms, and life stressful events. Methods Totally 461 patients were recruited from the department of neurology of Shenzhen People′s Hospital between June 2014 and June 2016. They all finished GAD-7 and PHQ-9, as well as our new scale Neuro-11 questionnaire. In order to validate criterion and test construct validity, questionnaire results from new scale Neuro-11 was compared with those of GAD-7 and PHQ-9. Further, psychiatrist diagnosis based on International Classification of Diseases-10 was established, and exploratory factor analysis(EFA) and receiver operating curve(ROC) was also performed. And internal consistency was tested for reliability. Results The new scale Neuro-11 contained 11 items from three dimensions, named somatic discomfort, negative emotions, and negative life events. A cutoff point of 10 was identified as optimized sensitivity(88%) and specificity(72%). Cronbach alpha was 0.73 and split-half reliability coefficient was 0.67. The score of Neuro-11 was strongly correlated with GAD-7 and PHQ-9, with correlation coefficients of 0.67 and 0.75, respectively.Conclusion Neuro-11 is a valid and efficient tool for screening neurotic disorders in general hospital.
Objective To establish a brief self-report scale(Neuro-11) to identify probable neurotic patients along with somatic discomfort, negative emotional symptoms, and life stressful events. Methods Totally 461 patients were recruited from the department of neurology of Shenzhen People′s Hospital between June 2014 and June 2016. They all finished GAD-7 and PHQ-9, as well as our new scale Neuro-11 questionnaire. In order to validate criterion and test construct validity, questionnaire results from new scale Neuro-11 was compared with those of GAD-7 and PHQ-9. Further, psychiatrist diagnosis based on International Classification of Diseases-10 was established, and exploratory factor analysis(EFA) and receiver operating curve(ROC) was also performed. And internal consistency was tested for reliability. Results The new scale Neuro-11 contained 11 items from three dimensions, named somatic discomfort, negative emotions, and negative life events. A cutoff point of 10 was identified as optimized sensitivity(88%) and specificity(72%). Cronbach alpha was 0.73 and split-half reliability coefficient was 0.67. The score of Neuro-11 was strongly correlated with GAD-7 and PHQ-9, with correlation coefficients of 0.67 and 0.75, respectively.Conclusion Neuro-11 is a valid and efficient tool for screening neurotic disorders in general hospital.
引文
[1] Ni C,Ma L,Wang B,et al.Screening and correlates of neurotic disorders among general medical outpatients in Xi′an China[J].Perspect Psychiatr Care,2014,51(2):128-135.
[2] Ni C,Ma L,Wang B,et al.Neurotic disorders of general medical outpatients in xi′an,china:Knowledge,attitudes,and help-seeking preferences[J].Psychiatr Serv,2014,65(8):1047-1053.
[3] Zhang W,Li X,Lin Y,et al.Pathways to psychiatric care in urban north china:A general hospital based study[J].Int J Ment Health Syst,2013,7(1):22.
[4] de Waal MW,Arnold IA,Spinhoven P,et al.The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care[J].Soc Psychiatry Psychiatr Epidemiol,2009,44(1):78-85.
[5] De Waal MW,Arnold IA,Eekhof JA,et al.Follow-up study on health care use of patients with somatoform,anxiety and depressive disorders in primary care[J].BMC Fam Pract,2008,9(1):5-8.
[6] Yu DS,Lee DT.Do medically unexplained somatic symptoms predict depression in older chinese?[J].Int J Geriatr Psychiatry,2012,27(2):119-126.
[7] Feder A,Olfson M,Gameroff M,et al.Medically unexplained symptoms in an urban general medicine practice[J].Psychosomatics,2001,42(3):261-268.
[8] Seivewright N,Tyrer P,Ferguson B,et al.Longitudinal study of the influence of life events and personality status on diagnostic change in three neurotic disorders[J].Depress Anxiety,2000,11(3):105-113.
[9] Irpati AS,Avasthi A,Sharan P,et al.Study of stress and vulnerability in patients with somatoform and dissociative disorders in a psychiatric clinic in north india[J].Psychiat Clin Neurosci,2006,60(5):570-574.
[10] Roca M,Gili M,Garcia-Garcia M,et al.Prevalence and comorbidity of common mental disorders in primary care[J].J Affect Disord,2009,119(1/3):52-58.
[11] Bener A,Al-Kazaz M,Ftouni D,et al.Diagnostic overlap of depressive,anxiety,stress and somatoform disorders in primary care[J].Asia Pac Psychiatry,2013,5(1):E29-E38.
[12] Chen S,Chiu H,Xu B,et al.Reliability and validity of the phq-9 for screening late-life depression in chinese primary care[J].Int J Geriatr Psychiatry,2010,25(11):1127-1133.
[13] Wang W,Bian Q,Zhao Y,et al.Reliability and validity of the chinese version of the patient health questionnaire (phq-9) in the general population[J].Gen Hosp Psychiatry,2014,36(5):539-544.
[14] Kroenke K,Spitzer RL,Williams JB,et al.Anxiety disorders in primary care:Prevalence,impairment,comorbidity,and detection[J].Ann Intern Med,2007,146(5):317-325.
[2] Ni C,Ma L,Wang B,et al.Neurotic disorders of general medical outpatients in xi′an,china:Knowledge,attitudes,and help-seeking preferences[J].Psychiatr Serv,2014,65(8):1047-1053.
[3] Zhang W,Li X,Lin Y,et al.Pathways to psychiatric care in urban north china:A general hospital based study[J].Int J Ment Health Syst,2013,7(1):22.
[4] de Waal MW,Arnold IA,Spinhoven P,et al.The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care[J].Soc Psychiatry Psychiatr Epidemiol,2009,44(1):78-85.
[5] De Waal MW,Arnold IA,Eekhof JA,et al.Follow-up study on health care use of patients with somatoform,anxiety and depressive disorders in primary care[J].BMC Fam Pract,2008,9(1):5-8.
[6] Yu DS,Lee DT.Do medically unexplained somatic symptoms predict depression in older chinese?[J].Int J Geriatr Psychiatry,2012,27(2):119-126.
[7] Feder A,Olfson M,Gameroff M,et al.Medically unexplained symptoms in an urban general medicine practice[J].Psychosomatics,2001,42(3):261-268.
[8] Seivewright N,Tyrer P,Ferguson B,et al.Longitudinal study of the influence of life events and personality status on diagnostic change in three neurotic disorders[J].Depress Anxiety,2000,11(3):105-113.
[9] Irpati AS,Avasthi A,Sharan P,et al.Study of stress and vulnerability in patients with somatoform and dissociative disorders in a psychiatric clinic in north india[J].Psychiat Clin Neurosci,2006,60(5):570-574.
[10] Roca M,Gili M,Garcia-Garcia M,et al.Prevalence and comorbidity of common mental disorders in primary care[J].J Affect Disord,2009,119(1/3):52-58.
[11] Bener A,Al-Kazaz M,Ftouni D,et al.Diagnostic overlap of depressive,anxiety,stress and somatoform disorders in primary care[J].Asia Pac Psychiatry,2013,5(1):E29-E38.
[12] Chen S,Chiu H,Xu B,et al.Reliability and validity of the phq-9 for screening late-life depression in chinese primary care[J].Int J Geriatr Psychiatry,2010,25(11):1127-1133.
[13] Wang W,Bian Q,Zhao Y,et al.Reliability and validity of the chinese version of the patient health questionnaire (phq-9) in the general population[J].Gen Hosp Psychiatry,2014,36(5):539-544.
[14] Kroenke K,Spitzer RL,Williams JB,et al.Anxiety disorders in primary care:Prevalence,impairment,comorbidity,and detection[J].Ann Intern Med,2007,146(5):317-325.