综合医院躯体形式障碍筛查量表的编制和初步应用

A Novel Self-report Screening Scale to Predict Somatoform Disorders

目的将躯体症状、情感症状及负性事件三者结合,编制一份适合在综合医院实施的躯体形式障碍筛查量表并进一步验证其信度、效度。方法通过查阅文献、参考中国精神疾病分类中躯体形式障碍的诊断标准(第3版)(Chinese Classification of Mental Disorders,third edition,CCMD-3)、国际疾病分类(International Classification of Diseases,ICD)-10躯体形式障碍诊断标准,结合临床经验构建躯体形式障碍三维度量表模型,包括躯体症状、负性情感、负性事件3项条目,并进行预调查条目分析和验证预问卷模型,形成躯体形式障碍筛查量表(简称Neuro-11)。对2014年6月-2016年6月就诊于深圳市人民医院神经内科的461例患者进行基本资料、躯体形式障碍筛查量表、广泛性焦虑量表(theseven-item generalized anxiety disorder scale,GAD-7)、9项患者健康问卷(patient health questionnaire-9,PHQ-9)的调查及测评,精神科医师根据ICD-10躯体形式障碍诊断标准进行电话访谈诊断,诊断结果为躯体形式障碍诊断的金标准。分析各人口学特点的得分情况,通过ROC曲线分析该量表的临界值,分析量表的内部信度及效标效度,分析量表3个维度之间的关系。结果 Neuro-11包含3个维度及11个条目,3个维度分别为躯体症状、负性情感及负性事件。当量表得分≥10分时,可认为患者有躯体形式障碍倾向,所对应的敏感度为0.88,特异度为0.72。Neuro-11的内部一致性Cronbach α系数为0.73,分半信度系数为0.68;并且随着Neuro-11的得分升高,GAD-7、PHQ-9的得分也升高。结论综合医院躯体形式障碍筛查量表的三维理论合理,对躯体形式障碍的诊断价值良好,具有良好的信度、效度,并且可作为躯体形式障碍严重程度的衡量工具。

Objective To develop and validate a brief self-report scale(Neuro-11) including somatic discomfort, negative emotional symptoms and negative life events three dimensions, to identify probable patients with somatoform disorders.Methods Neuro-11 was derived from Chinese Classification of Mental Disorders-3(CCMD-3), International Classification of Diseases 10(ICD-10), related literature and clinical experience, and questionnaire investigation. The Neuro-11 scale includes three dimensions: somatic discomfort, negative emotional symptoms and negative life events, and the items of which were selected by discrimination, homogeneity and exploratory factor analysis. A total of 461 patients from Department of Neurology from Shenzhen People’s Hospital from June 2014 to June 2016 were randomly selected and evaluated using the seven-item generalized anxiety disorder scale(GAD-7), patient health questionnaire-9(PHQ-9) and Neuro-11. The final diagnosis of these patients was determined based on the results of telephone interview by psychiatrists according to the diagnosis criterion of somatoform disorders of ICD-10. The evaluation results of three scales were compared to analyze the criterion validity of Neuro-11. Receiver operating characteristic(ROC) curve of the Neuro-11 was plotted and internal consistency was tested for its reliability.Results The scale Neuro-11 contains three dimensions and 11 items. When the score of this new scale is equal or greater than 10 points, the patient may have somatoform disorders. The sensitivity of Neuro-11 was 88% and the specificity was 72%. Cronbach alpha was 0.73 and split-half reliability coefficient was 0.68. The score of Neuro-11 was strongly correlated with that of GAD-7 and PHQ-9.Conclusions Neuro-11 is a valid and efficient tool for screening somatoform disorders and assessing its severity in general hospital.