超短抑郁焦虑筛查量表在综合医院住院患者抑郁焦虑状态评估中的应用

Application of Patient Health Questionnaire-4 in the evaluation of depression and anxiety status of inpatients in general hospitals

目的探讨超短抑郁焦虑筛查量表(PHQ-4)筛查综合医院住院患者抑郁和焦虑的可行性。方法采用便利抽样法,选取2021年1—6月南京市10所二级甲等以上综合医院的695例住院患者为研究对象,使用PHQ-4、9项患者健康问卷(PHQ-9)和广泛性焦虑量表(GAD-7)对其进行调查,比较不同测量工具对患者抑郁、焦虑的筛查结果,采用受试者工作特征(ROC)曲线分析PHQ-4的预测价值,Kappa检验分析一致性,采用Cronbach'sα系数评估量表的内部一致性,Pearson相关分析评价校标关联效度。本研究共发放问卷695份,回收有效问卷672份,有效回收率为96.69%(672/695)。结果672例综合医院住院患者中,使用PHQ-4患者抑郁焦虑检出率为38.39%(258/672),使用PHQ-9和GAD-7患者抑郁焦虑检出率为41.82%(281/672),差异无统计学意义(χ2=1.64,P=0.20)。PHQ-4的Cronbach'sα系数为0.913,折半信度系数为0.888。PHQ-4与PHQ-9、GAD-7对抑郁焦虑筛查结果一致性检验Kappa值为0.756(P<0.01)。672例综合医院住院患者PHQ-4总分与PHQ-9、GAD-7总分的相关系数分别为0.822、0.802(均P<0.01)。PHQ-4的ROC曲线下面积为0.936,以3分为临界值,PHQ-4的灵敏度和特异度分别为81.9%和92.8%。结论PHQ-4与PHQ-9、GAD-7心理测评量表对综合医院住院患者抑郁、焦虑状态的检出率相似,并具有较好的信度和效度,适用于综合医院住院患者抑郁和焦虑的筛查。

Objective To evaluate the feasibility of using Patient Health Questionnaire-4(PHQ-4)to screen for depression and anxiety in inpatients in general hospitals.MethodsUsing the convenient sampling method,a total of 695 inpatients from 10 ClassⅡGrade A and above comprehensive hospitals in Nanjing from January to June 2021 were selected as the research objects.They were investigated by PHQ-4,Patient Health Questionnaire-9(PHQ-9)and Generalized Anxiety Disorder 7(GAD-7)to compare the screening results of different measuring tools for depression and anxiety.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of PHQ-4,Kappa test was used to analyze the consistency,Cronbach'sαcoefficient was used to evaluate the internal consistency of the scale,and Pearson correlation analysis was used to evaluate the calibration correlation validity.A total of 695 questionnaires were sent out in this study,and 672 were effectively collected,with an effective recovery rate of 96.69%(672/695).ResultsAmong 672 inpatients in general hospitals,the detection rate of depression and anxiety in patients using PHQ-4 was 38.39%(258/672),while that in patients using PHQ-9 and GAD-7 was 41.82%(281/672),and the difference showed no statistical significance(χ2=1.64,P=0.20).Cronbachs'αcoefficient of PHQ-4 was 0.913,and the half reliability coefficient was 0.888.The Kappa value of the consistency test between PHQ-4,PHQ-9,and GAD-7 for depression and anxiety screening results was 0.756(P<0.01).The correlation coefficients between the total scores of PHQ-4,PHQ-9 and GAD-7 in 672 inpatients from general hospitals were 0.822 and 0.802,respectively(bothP<0.01).The area under the ROC curve of PHQ-4 was 0.936.With a critical score of 3,the sensitivity and specificity of PHQ-4 were 81.9%and 92.8%,respectively.ConclusionsThe detection rate of PHQ-4 and PHQ-9 and GAD-7 on depression and anxiety state of inpatients in general hospital is similar,and has good reliability and validity,which is suitable for the screening of depression and anxiety of inpatients in general hospital.