患者健康问卷量表在评估系统性红斑狼疮患者抑郁障碍中的应用

The application of the Patient Health Questionnaire in the evaluation of depression in patients with systemic lupus erythematosus

目的评估患者健康问卷抑郁量表(PHQ-9)、患者健康问卷躯体症状群量表(PHQ-15)在诊断系统性红斑狼疮(SLE)患者抑郁障碍中的应用价值。方法选取142例SLE患者,由精神心理科医师使用汉密尔顿抑郁量表17项(HAMD-17)评估抑郁情况,风湿专科医师对患者进行疾病活动度(SLEDAI)评分,并进行PHQ-9、PHQ-15的患者自我评估,分析患者健康问卷量表的内部一致性及结果判定的相关性,并建立HAMD-17的多重线性回归模型。结果组内相关系数检验结果提示PHQ-9与HAMD-17(ICC=0.976,P<0.01)、PHQ-15与HAMD-17(ICC=0.869,P<0.01)判断抑郁的一致性非常好。将评分分级行一致性kappa分析,显示两种健康问卷量表和HAMD-17存在判断抑郁障碍结果之间的一致性(P<0.01)。相关性分析提示HAMD-17与SLEDAI、PHQ-9、PHQ-15两两相关(P<0.05),多重线性回归分析提示HAMD-17受到PHQ-9、PHQ-15的影响(F=106.600,P=0.000,R^(2)=0.758),并得出HAMD-17的回归方程:HAMD-17=2.362+0.557×PHQ-9+0.382×PHQ-15。结论患者健康问卷量表与HAMD-17量表对SLE患者抑郁障碍的评估高度一致,建议使用PHQ-9、PHQ-15在SLE患者中进行抑郁障碍的初筛。

Objective To analyze the correlation between Hamilton Depression Scale 17(HAMD-17),Patient Health Questionnaire Depression Scale(PHQ-9)and Patient Health Questionnaire Somatic Symptom Scale(PHQ-15)in assessing the severity of depression in patients with systemic lupus erythematosus(SLE).Methods A total of 142 patients with SLE were selected.The HAMD-17 scale was applied to assess depression by psychiatrists,and rheumatologists scored the patients with SLEDAI and performed PHQ-9,PHQ-15 patient self-assessment.The internal consistency of the patient′s health questionnaire was analyzed,and a multiple linear regression model of HAMD-17 was also established.Results Correlation analysis indicated that HAMD-17 was significantly correlated with SLEDAI,PHQ-9 and PHQ-15(P<0.05).The calculation of Cronbach′s coefficient on the scale indicates a high degree of internal consistency(Cronbach′α>0.7).The intra-group correlation coefficient test showed that the consistency of PHQ-9 and HAMD-17(ICC=0.976,P<0.01),and PHQ-15 and HAMD-17(ICC=0.869,P<0.01)were very good.The Kappa analysis showed that the results of the three scales were significantly consistent(P<0.01).Multiple linear regression analysis indicated that HAMD-17 was affected by PHQ-9 and PHQ-15(F=106.600,P=0.000,R^(2)=0.758),and the two independent variables can explain 75.8%of the variance of the outcome variable.The regression equation of HAMD-17 was HAMD-17=2.362+0.557×PHQ-9+0.382×PHQ-15.Conclusion The Patient Health Questionnaire and the Hamilton Depression Scale are highly consistent in the evaluation of depression in patients with SLE.It is recommended to use PHQ-9 and PHQ-15 to screen depression in SLE patients.