应用团体量表筛选人群心理障碍患者的有效性研究

Validity of Applying Questionnaires for Screening Mental Disorder in a Population

目的筛选心理障碍患者快捷有效的最佳工具。方法以驻桂某部入伍3个月新兵、桂林某大学在校学生以及桂林市某社区居民为受检对象,分别用症状自评量表(Symptom Checklist90,SCL-90)、康奈尔医学指数(Cornell Medical Index,CMI)、大学生人格问卷(University Personality Inventory,UPI)和WHO神经症筛选表进行检测,而后逐例做临床精神检诊,以《中国精神障碍分类与诊断标准第3版(CCMD-3)》为标准,对符合标准的心理障碍患者作出临床诊断,用效标效度检验,评价各量表的有效性。结果 WHO神经症筛选表评分效标效度的灵敏度为100%,特异度为94.26%;SCL-90的灵敏度为44.90%,特异度为85.89%;CMI的灵敏度为42.75%,特异度为84.56%;UPI的灵敏度为90.59%,特异度为43.66%。结论 WHO神经症筛选表的灵敏度、特异度均为最好,但操作费时费力,适用性受限,不是理想的团体筛选量表;SCL-90与CMI的灵敏度不理想,约一半以上的患者被漏筛,难以成为团体测验的筛选工具;UPI的灵敏度高,可筛选出绝大多数患者,量表有测伪项目,可将不真实、不认真填写而遗漏的患者进行重测补救,且测前有30min时间进行心理卫生宣传和介绍防治人员服务内容、联系方法,使存在问题的人主动应询,可避免遗漏,是值得推荐的团体量表筛选工具。

Objective To get the rapid and efficient method for screening mental disorders. Methods The newly recruited soldiers enrolling for 3 months stationed at Guilin,some students in a university in Guilin,some citizens in a community and nearby areas in Guilin were studied. Symptom Checklist 90 （SCL-90）,Connell Medicine Index （CMI）,University Personality Inventory （UPI） and WHO deliration screening questionnaire were applied to test the subjects respectively. Then clinical interview and examination were performed on each case and clinical diagnosis for the mental disorder was made based on CCMD-3 standard. The validity of each questionnaire was evaluated by using criterion-related validity. Results For the mental disorder screening,the sensitivity and specificity of WHO deliration screening questionnaire were 100% and 94.26%,of SCL-90 were 44.90% and 85.89%,of CMI were 42.75% and 84.56%,of UPI were 90.59% and 43.66%. Conclusion WHO deliration screening questionnaire is the best in both sensitivities and specificities,but its manipulation is time-consuming and laborious,which limits its application and make it away from the best method to screen mental disorders in a population. SCL-90 and CMI are imperfect in sensitivities and more than a half patients will be missed,so they can hardly server as ascreening tool. UPI has high sensitivity and can screen out most of the patients with mental disorder. Additionally,UPI questionnaire contains fake-test item,which can be used to retest the unselected patients with mental disorder who answer the questionnaire untruly and halfheartedly. Especially,through 30 minutes of mental health propaganda,introduction of service contents and contact method,people with problem can initiatively inquire and missed screening can be avoided. UPI is a valuable screening tool to be recommended for mental disorder in a population.