抑郁和躯体症状量表在冠心病患者中筛查抑郁的效度和信度

Validity and reliability of the depression and somatic symptoms scale for screening depression among patients with coronary heart disease

目的评估抑郁和躯体症状量表(depression and somatic symptoms scale,DSSS)在冠心病患者中应用的效度和信度。方法选取综合医院冠心病患者246例,完成DSSS、汉密尔顿抑郁量表(Hamilton depression rating scale for depression,HAMD)和病人健康问卷(patients’health questionnaire depression scale-9 item,PHQ-9)测评。使用探索性因子分析和验证性因子分析评估量表的结构效度。以接受过简明国际神经精神访谈(mini international neuropsychological interview,MINI)培训的精神科医生根据ICD-10做出的"金标准"来评估DSSS的效度。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析确定DSSS筛查抑郁的临界值。采用Cronbachα系数评估内部一致性。结果探索性因子分析得到2个子量表:抑郁子量表和躯体子量表,共解释总方差的51.8%。验证性因子分析的拟合指标为:χ^(2)/df=3.636,RMR=0.077,RMSEA=0.104,IFI=0.804,TLI=0.781,CFI=0.802。DSSS与HAMD的组内相关系数(intraclass correlation coefficient,ICC)为0.54。DSSS的ROC曲线下面积为0.828,以17分为临界值时,灵敏度(81%)和特异度(75%)最为理想。抑郁发作组DSSS总分、子量表得分均高于非抑郁发作组(均P<0.01)。DSSS的内部一致性Cronbachα系数为0.917。结论DSSS在冠心病患者抑郁评估中具有良好的效度和信度,可应用于综合医院冠心病患者的抑郁初筛。

Objective To assess the validity and reliability of the depression and somatic symptoms scale among patients with coronary heart disease.Methods Totally 246 patients with coronary heart disease were assessed with depression and somatic symptoms scale(DSSS),Hamilton depression rating scale for depression(HAMD)and patients’health questionnaire depression scale-9 item(PHQ-9).The structural validity was evaluated with exploratory factor analysis and confirmatory factor analysis.The validity as a screening tool was evaluated with the gold standard diagnosed by psychiatrists who were trained with the mini international neuropsychological interview(MINI)according to ICD-10.Receiver operating characteristic(ROC)curve was used to identify cutoff scores for depression.Cronbachαcoefficient was used to evaluate the internal consistency.Results Exploratory factor analysis yielded two factors:depression factor and somatic factor,and the cumulative variance was 51.8%.The fitting indexes of confirmatory factor analysis were as follows:χ2/df=3.636,RMR=0.077,RMSEA=0.104,IFI=0.804,TLI=0.781,CFI=0.802.The intraclass correlation coefficient of DSSS and HAMD was 0.54.The area under ROC curve(AUC)was 0.828,and the best boundary value was 17 points(sensitivity and specificity:81%and 75%,respectively).The total scores and subscale scores for internal consistency of DSSS were higher in the depression group than those in the non-depression group(P<0.01).Cronbachαcoefficient for internal consistency of DSSS was 0.917.Conclusion The DSSS has good validity and reliability among patients with coronary heart disease for screening depression,and can be used to screen depression among patients with coronary heart disease in general hospital.