儿童期虐待史问卷在社区人群中的信度和效度检测(英文)

Reliability and validity of Childhood Experience of Care and Abuse Questionnaire in the community population

背景:英国伦敦大学精神病学研究所编制的儿童期虐待史问卷在国外社区成年人群和情感障碍的患者测评中,都被证实有较好的信度和效度,但是该问卷在中国使用还需进行各种群体的信度和效度验证。目的:分析儿童期虐待史问卷在社区人群中的信效度。设计:随机选择对象,按量表信度和效度分析的原则进行实施。单位:中南大学精神卫生研究所。对象:于2003-09/2004-02选择来自湖南长沙市和河南新乡市的两个社区的成年人群608人作为社区普通人群组,发放儿童期虐待史问卷608份,剔出无效问卷8份,共计600人完成了这项调查。随机从河南省精神病院住院的抑郁性疾病患者中,抽取60例成人患者组成抑郁性疾病患者组。方法:对社区普通人群组和抑郁性疾病患者组进行了儿童期虐待史问卷测试,主要为回顾性地调查成年人在童年时是否存在躯体、性或精神方面虐待的自评量表。其中精神虐待又包括憎恶和忽视2个因子(各含8个条目)。对条目的回答被量化为5个等级分值。由受试者评定其父母是否存在施虐的情况。分值越高则表明遭受精神虐待的程度越大。社区人群经儿童期虐待史问卷评定为有儿童躯体虐待和性虐待史的40例阳性样本和评定阴性的560例样本中随机抽查40例,再行Bifulco提供的儿童期虐待史晤谈(CECA)的评定。普通人群组中有100名还同时评定了Zung抑郁自评量表,另外有30名受试者于首次测定2周后进行重测儿童期虐待史问卷。主要观察指标:分析儿童期虐待史问卷的内部一致性,重测信度,内容及校标效度。结果:社区人群中剔出无效问卷8份后,余600例进入统计分析。①儿童期虐待史问卷的信度及重测信度:儿童期虐待史问卷的精神虐待部分的Cronbach’sа系数为0.87(其中母亲为0.85,父亲为0.83),其中憎恶因子为0.84(其中母亲为0.80,父亲为0.81),忽视因子为0.85(其中母亲0.84,父亲0.83)。精神虐待的重测信度0.83(其中母亲0.81,父亲082),其中憎恶因子为0.81(其中母亲为0.82,父亲为0.70),忽视因子为0.79(其中母亲0.78,父亲0.75);躯体及性虐待的两次测评的一致性好(Kappa值为0.78)。②儿童期虐待史问卷的校标效度:儿童期虐待史问卷精神虐待及憎恶、忽视因子与Zung抑郁自评量表的相关系数依次为0.58、0.55、0.60(P值均<0.01)。儿童期虐待史问卷与儿童期虐待史晤谈评定提纲(CECA)评定躯体及性虐待史的一致性好,抑郁性患者的精神虐待分值高于社区人群的精神虐待分值(P<0.05)。结论:儿童期虐待史问卷在社区人群中也具有较好的信、效度,在中国可作为社区人群的回顾性儿童期虐待史筛选调查的自评工具。

BACKGROUND： The Childhood Experience of Care and Abuse Questionnaire （CECA.Q） compiled by the Institute of Psychiatry, University of London, has been verified to have good reliability and validity in the assessment of foreign community adults and patients with affective disorder, but the application of CECA.Q in China still needs verification of reliability and validity in various population. OBJECTIVE： To analyze the reliability and validity of CECA.Q in community population. DESIGN： The subjects were randomized selected; the principle for the analysis of scale reliability and validity was followed. SETTING： Mental Health Institute of Central South University. PARTICIPANTS： From September 2003 to February 2004, 608 adults were selected from two communities of Hunan Changsha city and Henan Xinxiang city as the common community population group, totally 608 scales of CECA.Q were sent out, 8 invalid ones were excluded, and finally 600 subjects finished the investigation. Sixty adult inpatients with depressive disease were randomly selected from Henan Provincial Psychiatric Hospital as the depression group. METHODS： The common community population and patients with depressive disease were investigated with CECA.Q, which was a self-rating scale mainly to retrospectively survey whether the adults had suffered from physical, sexual or mental abuse in their childhood, and the mental abuse had two factors of antipathy and neglect, and each included 8 items. The answers for the items were quantified into 5 grades. The subjects evaluated whether their parents had given any abuse to them; the higher the score was, the greater the mental abuse they suffered. Of the community population, 40 cases were the positive samples with the history of physical and sexual abuse in childhood evaluated by CECA.Q, and they were then assessed with Bifulco provided childhood experience of care and abuse （CECA） together with 40 cases randomly selected from 560 samples with negative evaluation. A total of 100 cases in the community population were also evaluated with Zung self-rating depression scale （SDS）, besides, 30 cases were retested with CECA.Q .at 2 weeks after the first evaluation. MAIN OUTCOME MEASURES： The internal consistency, test-retest reliability, contents and criterion validity of CECA.Q were analyzed, RESULTS： Of the community population, 8 invalid questionnaires were excluded, and the other 600 cases entered the statistical analysis. ①Testretest reliability of CECA.Q： The Cronbach a coefficient for the mental abuse section was 0.87 （0.85 for maternal one, 0.83 for paternal one）; including that of antipathy factor was 0.84 （0.80 for maternal one, 0.81 for paternal one）, and that of neglect factor was 0.85 （0.84 for maternal one, 0.83 for paternal one. The testetest reliability coefficient for mental abuse was 0.83 （0.81 for maternal one, 082 for paternal one）, including that of antipathy was 0.81 （0.82 for maternal one, 0.70 for paternal one）, and that of neglect was 0.79 （0.78 for maternal one, 0.75 for paternal one）. The twice evaluations of physical and sexual abuse had good consistency （Kappa-0.78）. ②Criterion validity of CECA.Q： The correlation coefficients of mental abuse, antipathy and neglect factors in CECA.Q with Zung SDS were 0.58, 0.55 and 0.60 respectively （P 〈 0.01）. CECA.Q and CECA had good consistency in evaluating history of physical and sexual abuse, and the score of mental abuse in the depressive patients was higher than that in community population （P 〈 0.05）. CONCILUSION： The CECA.Q shows acceptable reliability and validity in community population, and can be used as a self-rating measure for childhood abuse experience in China.