病人健康问卷量表9在功能性胃肠病患者抑郁情绪评估中信效度的研究
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摘要
目的探讨病人健康问卷量表9(PHQ-9)在功能性胃肠病患者抑郁情绪评估中的信效度及最佳截止值。方法选取在广西壮族自治区人民医院消化内科就诊的功能性胃肠病患者158例,患者独立完成PHQ-9量表。然后由精神心理科或经过培训的专业医师对患者进行面对面访谈并作出诊断,作为抑郁诊断成立的"金标准"。统计分析PHQ-9的灵敏度、特异度,并进行信效度检验及绘制ROC曲线,确定PHQ-9筛查抑郁状态的最佳截止值。结果 PHQ-9量表内部一致性Cronbach’sα=0.826,ROC曲线下面积为0.761(95%置信区间为0.688～0.834),当截止值为6或以上时,灵敏性为90.77%,特异性为53.76%。结论在功能性胃肠病患者中,PHQ-9是筛查抑郁状态的有效工具,推荐最佳截止值为6分或以上。
Objective To evaluate the reliability,validity and the optimal cut-off value of Patient Health Questionnaire-9(PHQ-9)in the assessment of depression in functional gastrointestinal disorders(FGIDs).Methods A total of 158 patients with FGIDs were selected from the Department of Digestive Internal Medicine of People's Hospital of Guangxi Zhuang Autonomous Region.All patients completed the PHQ-9 scale independently.Then a face to face interview was performed by psychiatric and psychological or trained medical specialists,which was considered as the"gold standard"for confirmation of depression.The sensitivity and specificity of PHQ-9 were statistically analyzed,and reliability and validity tests were conducted and ROC curves were drawn to determine the optimal cut-off value of PHQ-9 for screening depression. Results The internal consistency(Cronbach'sα)of the PHQ-9 was 0.826,the area under the ROC curve was 0.761(95%CI 0.688～0.834),and the sensitivity and specificity were 90.77%and 53.76% when the cut-off value was 6 or above.Conclusion The PHQ-9 is an effective tool for screening depression state in functional gastrointestinal disorders,and the recommended best cut-off value is 6 points or above.
Objective To evaluate the reliability,validity and the optimal cut-off value of Patient Health Questionnaire-9(PHQ-9)in the assessment of depression in functional gastrointestinal disorders(FGIDs).Methods A total of 158 patients with FGIDs were selected from the Department of Digestive Internal Medicine of People's Hospital of Guangxi Zhuang Autonomous Region.All patients completed the PHQ-9 scale independently.Then a face to face interview was performed by psychiatric and psychological or trained medical specialists,which was considered as the"gold standard"for confirmation of depression.The sensitivity and specificity of PHQ-9 were statistically analyzed,and reliability and validity tests were conducted and ROC curves were drawn to determine the optimal cut-off value of PHQ-9 for screening depression. Results The internal consistency(Cronbach'sα)of the PHQ-9 was 0.826,the area under the ROC curve was 0.761(95%CI 0.688～0.834),and the sensitivity and specificity were 90.77%and 53.76% when the cut-off value was 6 or above.Conclusion The PHQ-9 is an effective tool for screening depression state in functional gastrointestinal disorders,and the recommended best cut-off value is 6 points or above.
引文
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[7]周春兰,刘颖,罗祥蓉.病人健康问卷抑郁自评量表在住院糖尿病足溃疡患者中应用的信效度研究[J].中国全科医学,2016,18(28):3461-3466.
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[19]Zhou X,Bi B,Zheng L,et al.The prevalence and risk factors for depression symptoms in a rural Chinese sample population[J].PLoS One,2014,9(6):e99692.
[20]Yang Z,Chen R,Hu X,et al.Factors that related to the depressive symptoms among elderly in urban and rural areas of China[J].Zhonghua Liu Xing Bing Xue Za Zhi,2017,38(8):1088-1093.
[21]符陈超,李勤.2型糖尿病合并抑郁的相关研究进展[J].海南医学,2018,29(13):1861-1865.
[22]罗红辉,陈炎城,李佳,等.对慢性阻塞性肺疾病稳定期患者焦虑抑郁的临床流行病学调查研究[J].黑龙江医学,2018,42(3):260-261.
[23]Zhao L,Li X,Zhang Z,et al.Prevalence,correlates and recognition of depression in Chinese inpatients with cancer[J].Gen Hosp Psychiatry,2014,36(5):477-482.
[24]杨玲俐,张志珺.卒中后抑郁的流行病学及临床特点[J].中国卒中杂志,2007(11):907-911.
[25]但小娟,陈彪.帕金森病抑郁研究进展[J].中华老年心脑血管病杂志,2012,14(8):889-891.
[26]李金英.PHQ-9和GAD-7量表在功能性胃肠病患者精神心理评测的应用研究[D].南宁:广西医科大学,2018.
[27]Chagas MH,Tumas V,Rodrigues GR,et al.Validation and internal consistency of Patient Health Questionnaire-9for major depression in Parkinson’s disease[J].Age Ageing,2013,42(5):645-649.
[28]胡星辰,张迎黎,梁炜,等.病人健康问卷抑郁量表(PHQ-9)在青少年中应用的信效度检验[J].四川精神卫生,2014,27(4):357-360.
[29]Janssen EP,Kohler S,Stehouwer CD,et al.The Patient Health Questionnaire-9as a Screening Tool for Depression in Individuals with Type 2Diabetes Mellitus:The Maastricht Study[J].J Am Geriatr Soc,2016,64(11):e201-e206.
[30]陈曼曼,胜利,曲姗.病人健康问卷在综合医院精神科门诊中筛查抑郁障碍的诊断试验[J].中国心理卫生杂志,2015,29(4):241-245.
[31]Arrieta J,Aguerrebere M,Raviola G,et al.Validity and Utility of the Patient Health Questionnaire(PHQ)-2and PHQ-9for Screening and Diagnosis of Depression in Rural Chiapas,Mexico:A Cross-Sectional Study[J].J Clin Psychol,2017,73(9):1076-1090.
[32]闵宝权,周爱红,梁丰,等.病人健康问卷抑郁自评量表(PHQ-9)的临床应用[J].神经疾病与精神卫生,2013,13(6):569-572.
[33]Mu珘noz-Navarro R,Cano-Vindel A,Medrano LA,et al.Utility of the PHQ-9to identify major depressive disorder in adult patients in Spanish primary care centres[J].BMC Psychiatry,2017,17(1):291.
[2]Keely S,Walker MM,Marks E,et al.Immune dysregulation in the functional gastrointestinal disorders[J].Eur J Clin Invest,2015,45(12):1350-1359.
[3]Hartono JL,Mahadeva S,Goh KL.Anxiety and depression in various functional gastrointestinal disorders:do differences exist?[J].J Dig Dis,2012,13(5):252-257.
[4]Thijssen AY,Jonkers DM,Leue C,et al.Dysfunctional cognitions,anxiety and depression in irritable bowel syndrome[J].J Clin Gastroenterol,2010,44(10):e236-e241.
[5]Banerjee A,Sarkhel S,Sarkar R,et al.Anxiety and Depression in Irritable Bowel Syndrome[J].Indian J Psychol Med,2017,39(6):741-745.
[6]左国文,梁列新.功能性胃肠病与精神障碍共病的流行病学研究进展[J].中国临床新医学,2015,8(7):691-695.
[7]周春兰,刘颖,罗祥蓉.病人健康问卷抑郁自评量表在住院糖尿病足溃疡患者中应用的信效度研究[J].中国全科医学,2016,18(28):3461-3466.
[8]杨海洪.9条目病人健康问卷抑郁量表在卒中后抑郁筛查中的应用价值[J].实用临床医药杂志,2016,20(8):28-30.
[9]孙沁怡,邱晨红,周华,等.PHQ-9、GAD-7量表对肿瘤患者抑郁及焦虑的诊断价值[J].医学临床研究,2015,32(12):2397-2399.
[10]Aziz I,Palsson OS,Tornblom H,et al.The Prevalence and Impact of Overlapping Rome IV-Diagnosed Functional Gastrointestinal Disorders on Somatization,Quality of Life,and Healthcare Utilization:A Cross-Sectional General Population Study in Three Countries[J].Am J Gastroenterol,2018,113(1):86-96.
[11]Qian J.Mental health care in China:providing services for under-treated patients[J].J Ment Health Policy Econ,2012,15(4):179-186.
[12]Saragoussi D,Christensen MC,Hammer-Helmich L,et al.Long-term follow-up on health-related quality of life in major depressive disorder:a 2-year European cohort study[J].Neuropsychiatr Dis Treat,2018,14:1339-1350.
[13]Brody DJ,Pratt LA,Hughes JP.Prevalence of Depression Among Adults Aged 20and Over:United States,2013-2016[J].NCHS Data Brief,2018,(303):1-8.
[14]Cia AH,Stangaro JC,Aguilar Gaxiola S,et al.Lifetime prevalence and age-of-onset of mental disorders in adults from the Argentinean Study of Mental Health Epidemiology[J].Soc Psychiatry Psychiatr Epidemiol,2018,53(4):341-350.
[15]Silva MT,Galvao TF,Martins SS,et al.Prevalence of depression morbidity among Brazilian adults:a systematic review and meta-analysis[J].Rev Bras Psiquiatr,2014,36(3):262-270.
[16]Grobe TG,Kleine-Budde K,Bramesfeld A,et al.Prevalences of Depression Among Adults:Comparative Analysis of a Nationwide Survey and Routine Data[J].Gesundheitswesen,2018.
[17]Subramaniam M,Abdin E,Sambasivam R,et al.Prevalence of Depression among Older Adults-Results from the Well-being of the Singapore Elderly Study[J].Ann Acad Med Singapore,2016,45(4):123-133.
[18]Liu H,He Y,Wang J,et al.Epidemiology of depression at Traditional Chinese Medicine Hospital in Shanghai,China[J].Compr Psychiatry,2016,65:1-8.
[19]Zhou X,Bi B,Zheng L,et al.The prevalence and risk factors for depression symptoms in a rural Chinese sample population[J].PLoS One,2014,9(6):e99692.
[20]Yang Z,Chen R,Hu X,et al.Factors that related to the depressive symptoms among elderly in urban and rural areas of China[J].Zhonghua Liu Xing Bing Xue Za Zhi,2017,38(8):1088-1093.
[21]符陈超,李勤.2型糖尿病合并抑郁的相关研究进展[J].海南医学,2018,29(13):1861-1865.
[22]罗红辉,陈炎城,李佳,等.对慢性阻塞性肺疾病稳定期患者焦虑抑郁的临床流行病学调查研究[J].黑龙江医学,2018,42(3):260-261.
[23]Zhao L,Li X,Zhang Z,et al.Prevalence,correlates and recognition of depression in Chinese inpatients with cancer[J].Gen Hosp Psychiatry,2014,36(5):477-482.
[24]杨玲俐,张志珺.卒中后抑郁的流行病学及临床特点[J].中国卒中杂志,2007(11):907-911.
[25]但小娟,陈彪.帕金森病抑郁研究进展[J].中华老年心脑血管病杂志,2012,14(8):889-891.
[26]李金英.PHQ-9和GAD-7量表在功能性胃肠病患者精神心理评测的应用研究[D].南宁:广西医科大学,2018.
[27]Chagas MH,Tumas V,Rodrigues GR,et al.Validation and internal consistency of Patient Health Questionnaire-9for major depression in Parkinson’s disease[J].Age Ageing,2013,42(5):645-649.
[28]胡星辰,张迎黎,梁炜,等.病人健康问卷抑郁量表(PHQ-9)在青少年中应用的信效度检验[J].四川精神卫生,2014,27(4):357-360.
[29]Janssen EP,Kohler S,Stehouwer CD,et al.The Patient Health Questionnaire-9as a Screening Tool for Depression in Individuals with Type 2Diabetes Mellitus:The Maastricht Study[J].J Am Geriatr Soc,2016,64(11):e201-e206.
[30]陈曼曼,胜利,曲姗.病人健康问卷在综合医院精神科门诊中筛查抑郁障碍的诊断试验[J].中国心理卫生杂志,2015,29(4):241-245.
[31]Arrieta J,Aguerrebere M,Raviola G,et al.Validity and Utility of the Patient Health Questionnaire(PHQ)-2and PHQ-9for Screening and Diagnosis of Depression in Rural Chiapas,Mexico:A Cross-Sectional Study[J].J Clin Psychol,2017,73(9):1076-1090.
[32]闵宝权,周爱红,梁丰,等.病人健康问卷抑郁自评量表(PHQ-9)的临床应用[J].神经疾病与精神卫生,2013,13(6):569-572.
[33]Mu珘noz-Navarro R,Cano-Vindel A,Medrano LA,et al.Utility of the PHQ-9to identify major depressive disorder in adult patients in Spanish primary care centres[J].BMC Psychiatry,2017,17(1):291.