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

Diagnostic test of screening depressive disorders in general hospital with the Patient Health Questionnaire

目的：用诊断试验探讨9条目病人健康问卷（PHQ-9）对抑郁障碍的筛查功能,检验其对不同严重程度抑郁症的划界值。方法：选取综合医院精神科就诊者319例,包括80例不符合任何精神科诊断的咨询者和239例精神障碍患者。所有受试均完成PHQ-9自评,以用简明国际神经精神访谈（M.I.N.I.）评估做抑郁障碍诊断为＂金标准＂,用汉密顿抑郁量表（HAMD）评估病情严重程度。结果：因子分析显示PHQ-9有较好的结构效度。符合抑郁障碍诊断46例,PHQ-9评分的ROC曲线下面积0.94（95%CI：0.91~0.97）;以15分为划界值时综合医院精神科门诊患者的抑郁障碍筛查的敏感度和特异度分别为83%和90%。以HAMD为标准,PHQ-9对轻度、中度、重度抑郁症的划界值为6分、12分、15分,以此划界值得出的PHQ-9等级和HAMD得出的严重程度的一致性评价kappa值为0.49;以量表制定者推荐的5、10、15分得出的PHQ-9等级和HAM D得出的症状程度的kappa值为0.46。PHQ-9的内部一致性系数为0.89。结论：9条目病人健康问卷具有良好的效度和信度,可用于综合医院中对抑郁障碍初筛和严重程度评估。量表制定者推荐的划界值适用于国内综合医院精神科抑郁障碍患者。

Objective： Using a diagnostic test research,to explore the reliability and validity of the Patient Health Questionnaire（ PHQ-9） on screening of depressive disorders in general hospital,and to determine the cut points for depressions w ith different severities.Methods： Three hundred and nineteen help-seekers（ n = 319） consulting the outpatient department of psychiatry in a general hospital w ere collected continuously.Among them,80 w ere people w ithout any psychiatric diagnosis,239 w ere patients w ith mental disorders.All of subjects w ere asked to fulfill PHQ-9,and w ere assessed by psychiatrist w ith Mini-International Neuropsychiatric Interview（ M.I.N.I.）and Hamilton rating scale for depression.M.I.N.I.w as gold standard to diagnose depressive disorder,HRSD w as used to assess the illness severity.Result： Factor analysis show ed good structure validity of PHQ-9.46 patients w ere diagnosed depressive disorders.The area under the receiver operator characteristic analysis（ ROC） of PHQ-9 w as0.94（ 95% CI： 0.91- 0.97） for depressive disorders.With 15 as the critical value for depression screening,the sensitivity w as 0.83 and specificity w as 0.90,respectively.By the result of HRSD as the standard to rank different levels of depression,the cut points of PHQ-9 for mild,moderate,and severe depression w as 6,12,and 15.The consistency betw een results of PHQ-9（ w ith cut points of 6,12,15） and HRSD w as moderate（ w ith kappa = 0.49）.The kappa betw een results of PHQ-9（ w ith recommended cut points of 5,10,and 15） and HRSD w as 0.46.Cronbach αcoefficient of PHQ-9 w as 0.892.Conclusion： It suggests that PHQ-9 has satisfying reliability and validity,and is applicable for screening depression and assessment of its severity of outpatients in general hospital.The recommended cut points of PHQ-9 are applicable to depressive outpatients in general hospital in China.