16项抑郁症状快速自评量表自杀条目在抑郁症自杀风险筛查中的有效性研究

A study on the application of QIDS-SR16 suicidal ideation item to screen the suicidality in patients with major depression disorder

目的:评价患者16项抑郁症状快速自评量表(QIDS-SR16)中的自杀条目能否作为抑郁症自杀风险评估的筛查工具。方法:入组来自中国5家精神病院的门诊抑郁症患者,使用简明国际神经精神访谈(MINI)5.0.0的自杀模块作为患者是否有自杀风险的标准,患者完成QIDS-SR16的抑郁症状自评后使用Kappa一致性检验将QIDS-SR16自杀条目的评估结果与MINI结果进行比较,使用受试者工作特征曲线进行准确性和特异度的评估。结果:共分析患者数据352例,使用MINI自杀模块和QIDS-SR16的自杀条目筛选出具有自杀风险的患者比例分别为23.3%和47.4%。一致性检验结果显示MINI自杀模块和QIDS-SR16的自杀条目评估结果存在一致性差异(Kappa=0.34,P<0.001),在QIDS-SR16自杀条目筛查判定自杀风险阳性的患者中(自杀条目得分≥1),60%(99/167)被MINI评估为无自杀风险。进一步按照QIDS-SR16自杀风险的严重程度进行分层分析,结果显示在这部分评估结果不一致的患者中,70%(69/99)判定为轻度自杀风险,20%(20/99)判定为中度自杀风险。QIDS-SR16自杀意念条目筛查自杀风险的诊断价值分析结果显示,当以QIDS-SR16的自杀条目≥1分为筛查标准,评估患者自杀风险的灵敏度为83.1%,特异度为63.6%,受试者工作特征曲线下面积为0.73(95%CI:0.68~0.78)。结论:利用症状评估工具QIDS-SR16量表中的单个条目进行自杀风险的筛查具有良好的敏感性及应用的便利性。QIDS-SR16的自杀条目能够对抑郁症人群自杀风险进行初步的筛查。

Objective:To evaluate whether the 16-item Quick Inventory of Depressive Symptoms Self-Report Scale(QIDS-SR16)item“suicidal ideation”can be used as a screening tool for depression suicide risk assessment.Method:Outpatients diagnosed with major depression disorder(MDD)in 5 psychiatric hospitals in China were recruited.Using the Mini International Neuropsychiatric Interview(MINI)5.0.0 diagnosed as golden standard of currently suicidal risk.All patients completed the QIDS-SR16 depressive symptom assessment.Kappa analysis was used to compare the consistent of QIDS-SR16 and the MINI assessment of suicide risk.Receiver operating characteristic curve was used to calculated sensitivity and specificity.Results:The data of 352 patients were analyzed and the proportions of suicidal risk screened by the MINI suicide module and suicidal ideation of QIDS-SR16 were 23.3%and 47.4%respectively.There were consistency differences between MINI suicide module and suicidal ideation of QIDS-SR16 item(Kappa=0.34,P<0.001).60%(99/167)of the positive suicide risk patients(QIDS-SR16 suicide item score≥1)were assessed by MINI as not at risk for suicide.Further stratified analysis according to the severity of suicide risk of QIDS-SR16 showed that 70%(69/99)of these patients with inconsistent evaluation results were judged as mild suicide risk and 20%(20/99)as moderate suicide risk.Using QIDS-SR16(cutoff score≥1)had a sensitivity of 83.1%,a specificity of 63.6%,and an AUC of 0.73(95%CI:0.68-0.78)in evaluating patients'suicidality.Conclusion:The suicide ideation item of the self-assessment tool of QIDS-SR16 has a good sensitivity and make it easier to identify people having risk of suicide,and can make a preliminary suicide screening in the depressive patients.