3种焦虑评定量表在综合医院门诊患者中的应用比较

Comparison of three scales to detect anxiety in general hospital outpatients： HADS, SAS and HAMA

目的探讨医院焦虑抑郁量表（HDAS）和焦虑自评量表（SAS）、汉密顿焦虑量表（HAMA）评定焦虑的一致性。方法采用多中心、横断面设计，在广州15家综合医院2000名焦虑抑郁调查样本中现场抽取229例HADS总分≥8的可疑焦虑抑郁患者，采用SAS、HAMA进行再次评定。结果HDAS、HAD—A、SAS量表内部一致性良好，Cronbach系数分别为0．866，0．849，0．832。相关分析显示，HADS总分、HAD—A因子分与SAS标准分、HAMA总分呈正相关，相关系数为0．494～0．874，相关有显著性（P〈0．01）。量表评定的一致性检验显示，SAS标准分≥46、≥50作为焦虑划界分与HAMA≥14分的一致性McNemar检验，Kappa值分别为0．524，0．449（P〈0．01）；HAD—A≥8作为焦虑划界分与HAMA≥14、SAS≥50、SAS≥46一致性检验，Kappa值分别为0．314，0．265，0．401（P〈0．01）。结论HDAS和SAS均具有良好的量表内部一致性，但HAD—A与SAS、HAMA间的焦虑评定一致性仅为轻到中等程度。

Objective To the hospital anxiety and depression scale （HADS） and the seff-rating anxiety scale（SAS） and hanfihon anxiety scale （HAMA） in assessment anxiety among outpatients in general hospital. Methods 229 outpatients from 15 general hospitals who have tested with HADS（ HADS ≥ 8 ）completed the SAS and HAMA. Analyses with respect to internal consistency, correlation analysis,and agreement （Kappa coefficient and McNemar test） at recommended cut-off score were performed. Results The HADS, HAD-A and SAS had high internal consistency with Cronbach coefficient （0. 866,0. 849,0. 832 respectively）. Significant positive correction was observed among HADS,HAD-A and SAS,HAMA score（ r=0. 494-0. 874, P〈0.01 ）. The best agreement with HAMA≥14 was HAD-A ≥8, SAS ≥46, their Kappa values were 0.314,0. 524 respectively （P 〈 0.01 ）. The Kappa values between HAD-A ≥ 8 and SAS i〉 46, SAS≥ 50 were 0. 401,0. 265 （P 〈 0.01 ）. Conclusion HDAS and SAS scale have high internal consistency. The agreement in assessment anxiety between HAD-A and SAS, HAMA at the best suitable cut-off score is mild to moderate.