躯体症状障碍B标准量表(中文版)在西部综合医院门诊患者中的信度和效度研究

The reliability and validity of Somatic Symptom Disorder-B Criteria Scale(Chinese Version)in the outpatients of general hospitals in west China

目的对躯体症状障碍B标准量表(中文版)(Chinese Version of the Somatic Symptom Disorder-B Criteria Scale,中文版SSD-12)在西部综合医院门诊患者中的信效度进行检验分析。方法采用方便抽样法,抽选四川大学华西医院门诊患者380例进行中文版SSD-12问卷自评。以Cronbach′sα系数、Spearman-Brown折半系数评价中文版SSD-12量表内部一致性。采用验证性因子分析法验证中文版SSD-12的"想法、感受、行为"3因子和单因子结构;以DSM-5临床定式检查-科研版的"躯体症状障碍"部分作为"金标准"对中文版SSD-12不同得分段抽选的165例患者进行访谈,检验其效标效度;通过计算中文版SSD-12与患者健康问卷躯体症状群量表(Patient Health Questionnaire-15,PHQ-15)、躯体症状量表-8(Somatic Symptom Scale-8,SSS-8)、患者健康问卷抑郁量表(Patient Health Questionnaire-9,PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder-7,GAD-7)、健康焦虑量表(Whiteley Index-8 Scale,WI-8)之间的Pearson相关系数来评价其平行效度。结果回收有效自评量表369份,有效访谈问卷164份。中文版SSD-12的Cronbach′sα=0.95、Spearman-Brown折半系数为0.93,2周后重测Pearson′sr=0.91(P<0.01);验证性因子分析得到中文版SSD-12基本拟合了3因子结构[比较拟合指数(comparative fit index,CFI)=0.954、Tucker-Lewis指数(Tucker-Lewis index,TLI)=0.941、近似均方根误差(root mean square error of approximation,RMSEA)=0.089,90%可信区间(confidence interval,CI):0.076~0.102]和单因子结构(CFI=0.947,TLI=0.935,RMSEA=0.094,90%CI:0.081~0.106)两种模型。中文版SSD-12的曲线下面积(area under the curve,AUC)=0.902(95%CI:0.853~0.952,P<0.01),截断值为17分(敏感度为94.40%,特异度为82.80%)。中文版SSD-12总分与PHQ-15、SSS-8、GAD-7、PHQ-9、WI-8总分之间的Pearson相关系数分别为:0.54、0.63、0.62、0.53、0.79(均P<0.01)。结论躯体症状障碍B标准量表(中文版)在西部综合医院门诊患者中具有较好的信度和效度。

Objective To test the reliability and validity of the Somatic Symptom Disorder-B Criteria Scale(Chinese Version)in the outpatients of general hospitals in west China.Method A total of 380 outpatients who visited their doctors at Huaxi Medical Center of Sichuan University were recruited into the study through a convenience sampling.Cronbach′sαand Spearman-Brown halving coefficient were used to evaluate the internal consistency of the Chinese Version of SSD-12.Confirmatory factor analysis(CFA)was used to check a three-factor(cognitive,affective and behavioral)and a general one-factor structure of the Chinese Version of SSD-12;The SSD section of the Structured Clinical Interview for DSM Disorders,Fifth Edition,Research Version(SCID-5-RV)was used as the“gold standard”to interview 165 patients,selected in different scores ranges of the Chinese Version of SSD-12,to test the criterion validity.Pearson correlation coefficients were calculated to test the convergent validity by the association with Patient Health Questionnaire-15(PHQ-15),Somatic Symptom Scale-8(SSS-8),Patient Health Questionnaire-9(PHQ-9),Generalized Anxiety Disorder-7(GAD-7)and Whiteley Index-8 Scale(WI-8).Result A total of 369 effective self-assessment scales and 164 effective interview questionnaires were selected in the final analysis,the Cronbach′sαcoefficient and Spearman-Brown halving coefficient of the Chinese Version of SSD-12 scale were 0.95 and 0.93,respectively.The two-week retest Pearson′s r=0.91(P<0.01).The confirmatory factor analysis(CFA)fit a three-factor structure model(comparative fit index(CFI)=0.954,Tucker-Lewis index(TLI)=0.941,root mean square error of approximation(RMSEA)=0.089,90%CI:0.076-0.102),and a general one-factor model(CFI=0.947,TLI=0.935,RMSEA=0.094,90%CI:0.081-0.106)of the SSD-12.The area under the curve(AUC)of the Chinese version SSD-12 was 0.902(95%CI:0.853-0.952,P<0.01),the cutoff value was 17 points with the sensitivity 94.40%and the specificity 82.80%.The Pearson correlation coefficients between the Chinese version of SSD-12 and PHQ-15,SSS-8,GAD-7,PHQ-9,and WI-8 were 0.54,0.63,0.62,0.53 and 0.79 accordingly(P<0.01 for all).Conclusion The Chinese Version of SSD-12 presents with pretty high reliability and validity in the outpatients of general hospitals in China.