轻度认知障碍患者抑郁筛查工具的临床应用选择

Clinical selection of depression screening tools in patients with mild cognitive impairment

目的探讨患者健康问卷抑郁量表(PHQ-9)和老年抑郁量表(GDS-15)对轻度认知障碍(MCI)患者抑郁的筛查能力,初步评价其信效度。方法选取2019年5月—2021年6月解放军总医院、北京市和平里社区卫生服务中心门诊就诊的509例MCI患者作为研究对象,采用Cronbach'sα系数评估量表的内部一致性,Kappa值评定量表一致性,采用验证性因子分析量表的结构效度、非参数检验其已知族群效度。结果非参数检验结果显示不同睡眠问题的患者2个量表得分差异均具有统计学意义(P<0.05)。PHQ-9和GDS-15的Cronbach'sα系数分别为0.828和0.709,2个量表的Kappa值为0.560(P<0.05);PHQ-9模型第3条目的标准化路径回归系数较低(β=0.10),其余均较高;GDS-15的模型条目10(β=0.02)和条目13(β=0.29)的标准化路径回归系数较低,其余均较高。结论PHQ-9和GDS-15均是MCI患者抑郁症状评估的有效工具,但GDS-15部分条目不适合MCI人群应用;而PHQ-9结构效度好,测量结果更准确且使用便捷,适用于我国MCI患者抑郁症状筛查。

Objective To explore the screening capability of the Patient Health Questionnaire-9(PHQ-9)and the Geriatric Depression Scale(GDS-15)for depression in patients with mild cognitive impairment(MCI),and to preliminarily evaluate their reliability and validity.Methods A total of 509 patients with MCI who visited the outpatient clinic of the People's Liberation Army General Hospital and Beijing Hepingli Community Health Service Center from May 2019 to June 2021 were selected as the research object.The internal consistency of the scale was assessed by the Cronbach'sαcoefficient,and the consistency of the scale was assessed by the Kappa value.The construct validity of the scale was analyzed with the confirmatory factor analysis and the known population validity was tested by nonparametric test.Results The nonparametric test showed that there were statistically significant differences in the scores of the two scales among patients with different sleep problems(P<0.05).The Cronbach'sαof PHQ-9 and GDS-15 were 0.828 and 0.709,respectively,and the Kappa value of the two scales was 0.560(P<0.05).The standardized path regression coefficient of the third item of the PHQ-9 model was low(β=0.10),and the rest were higher.The standardized path regression coefficient of item 10(β=0.02)and item 13(β=0.29)of GDS-15 model was low,and the rest were higher.Conclusions Both PHQ-9 and GDS-15 scales are effective tools for assessing depressive symptoms in MCI patients.However,some items of GDS-15 are not suitable for MCI patients,while PHQ-9 scale has good construct validity and accurate measurement results,and is convenient to use and suitable for screening of depressive symptoms in MCI patients in China.