两条目患者健康问卷抑郁量表在卒中后抑郁筛查中的应用

Application of the two-item Patient Health Questionnaire Depression Scale in screening for post-stroke depression

目的探讨两条目患者健康问卷抑郁量表(PHQ-2)在卒中后抑郁(PSD)筛查中的应用价值。方法选取286例卒中后3～6个月的患者为研究对象。以中国精神障碍分类与诊断标准第3版(CCMD-3)为诊断PSD的标准,评估PHQ-2(≥3分)、汉密尔顿抑郁量表(HAMD,≥8分)诊断PSD的效能。结果①以CCMD-3为诊断标准,286例卒中患者中,PSD85例(发生率为29.7%),其中PHQ-2诊断PSD75例(26.2%),HAMD诊断PSD71例(24.8%)。②PHQ-2和HAMD量表诊断PSD的受试者工作特征曲线(ROC)下面积分别为0.827和0.838。③以CCMD-3为标准,PHQ-2诊断PSD的灵敏度为88.2%、特异度为77.1%、假阳性率为22.9%、假阴性率为11.8%、阳性预测值为88.2%、阴性预测值为77.1%、诊断符合率为80.4%。HAMD量表诊断PSD的上述指标分别为83.5%、84.1%、15.9%、16.5%、83.5%、84.1%、83.9%。结论 PHQ-2具有较好筛检价值,是早期发现卒中后抑郁患者简单、快速的筛查工具。

Objective To investigate the application value of the two-item Patient Health Questionnaire Depression Scale （PHQ-2） in screening for post-stroke depression （PSD）. Methods A total of 286 patients were selected as research objects within 3 to 6 months after stroke. The Classification and Diagnostic Criteria of Mental Disorders in China-Third Edition （ CCMD-3 ） was used as the diagnostic criteria of PSD. The diagnosing performance of PSD with PHQ-2 （ ≥ 3 ） and the Hamilton Depression Scale （ HAMD, ≥ 8） was evaluated. Results ①CCMD-3 was used as the diagnostic criteria, 85 of the 286 patients with stroke had PSD, and the incidence was 29.7% ; 75 patients were diagnosed as PSD with PHQ-2, and 71 were diagnosed as PSD with HAMD. ②The area under ROC curves of PHQ-2 and HAMD diagnosed PSD were 0. 827 and 0. 838, respectively. ③Using CCMD-3 as criteria, PHQ-2 diagnosed the sensitivity of PSD was 88.2% , the specificity was 77.1%, the false positive rate was 22.9% , the false negative rate was 11.8%, the positive predictive value was 88.2% , the negative predictive value was 77.1%, and the diagnostic accordance rate was 80.4%. The above indicators of HAMD diagnosed PSD were 83.5%, 84.1%, 15.9%, 16.5%, 83.5%, 84.1%, and 83.9%, respectively. Conclusion PHQ-2 has a better screening value and is a simple and rapid screening tool in the early detection of patients with post- stroke depression.