儿童焦虑障碍诊断和症状变化特征

Change characteristics in diagnosis and symptoms of childhood anxiety disorder

目的探讨儿童焦虑障碍诊断的稳定性及与症状变化之间的关系。方法 2012年10月—2014年10月采用整群抽样方法抽取河南信阳平桥区2所中心小学3~6年级5 233名7~13岁学生为调查对象,用长处和困难问卷（学生版）（SDQ）进行儿童焦虑障碍（anxiety disorders AD）的筛查,对阳性学生用儿童和青少年发育和健康状况评定量表（青少儿版）诊断,查出101例焦虑障碍患儿（AD）,其中86例参与随访,对其进行儿童焦虑障碍自评量表测量,并分别于2013年10月、2014年10月进行诊断和量表测量,依据是否自愈分为自愈组和持续组,采用重复测量资料的方差分析症状与诊断变化之间的交互影响及焦虑症状不同时点的变化趋势。结果 73例患儿完成基础和2次随访诊断和量表测量;2次随访中分别有45、50例患儿自愈,自愈率为61.64%、68.49%,自愈与性别（随访1：男生23例,女生22例,P〉0.05;随访2男生26例,女生24例,P=0.982）、年龄[随访1：（10.33±1.36）岁;随访2：（10.44±1.40）岁]无关联;症状部分,AD诊断与焦虑症状分趋势之间均有明显的交互作用（P〉0.05）,但持续组[基线：（30.05±13.43）分;随访1：（22.52±10.02）分;随访2：（22.62±7.38）分]和自愈组（基线：（27.40±11.62）分;随访1：（19.88±7.32）分;随访2：（17.61±5.54）分]之间的焦虑症状变化趋势差异无统计学意义（P=0.067）。结论儿童焦虑障碍诊断的稳定性低,缺乏临床效力。

Objective To explore the relationship between diagnostic stability and symptom variation in childhood anxiety disorder（ AD）. Methods With cluster sampling,5 233 pupils aged 7- 13 years（ grade 3- 6） were recruited from 2 primary schools in Pingyang district of Xinyang municipality,Henan province and screened for AD using Strengths and Difficulties Questionnaire（ SDQ） for students; the pupils with SDQ positive score were then tested with Development and Well-Being Assessment（ DAWBA） between October 2012 and October 2014. Of 101 pupils with AD diagnosis based on DAWBA test,86 were further assessed with Screen for Child Anxiety Related Emotional Disorder（ SCARED） and followed-up for 2 times of assessment with SCARED during October 2013 and 2014; the symptom variations and interaction between the variations and diagnosis among the 83 AD pupils with different clinic outcomes were analyzed using repeated measurement data. Chi-square tests,t test,and analysis of variance were adopted in the study. Results Totally 73 AD pupils completed the whole follow-up,of which,45 and 50（ 61. 64% and 68. 49%） were selfcured and no significant associations of gender and age with the self-cure were observed. The SCARED scores were27. 40 ± 11. 62,19. 88 ± 7. 32 and 17. 61 ± 5. 54 for the self-cured AD pupils and 30. 05 ± 13. 43,22. 52 ± 10. 02 and22. 62 ± 7. 38 for the uncured AD pupils at the basic measurement,first and second follow-up,respectively. There was a significant interaction between AD diagnosis and SCARED scores among the 73 AD pupils（ P = 0. 041）; but no significant associations of AD diagnosis with SCARED scores among the uncured AD pupils（ P = 0. 067）. Conclusion The diagnostic stability of childhood AD is lowand lack of clinical and pathological validity.