躯体症状自我筛查问卷在中国居民中的效度和信度

Validity and reliability of the Self-screening Questionnaire for Somatoform Symptoms among Chinese residents

目的评估躯体症状自我筛查问卷(SQSS)在中国普通居民中的效度和信度,分析功能躯体症状检出阳性的受试者一般特征。方法采用方便抽样法,于2020年2—3月通过问卷星向中国居民发送调查问卷,进行一般资料、SQSS、广泛性焦虑量表-7(GAD-7)、9项患者健康问卷(PHQ-9)和怀特利指数-7(WI-7)的施测。2周后采用随机数字表法选取100名受试者进行SQSS的重测。采用条目得分与量表总分的相关分析、极端组检验进行项目分析;采用探索性因素分析、验证性因素分析检验效度;采用内部一致性Cronbach'sα系数、分半信度系数和重测相关系数检验信度;采用χ^(2)检验、t检验比较功能性躯体症状筛查阳性及阴性者的一般资料及临床资料。结果共收集问卷1506份,剔除无效问卷56份,最终纳入1450名(96.3%)受试者。SQSS项目分析结果显示各条目得分与量表总分均呈正相关(r=0.49~0.70,均P<0.001),量表各条目区分度分析结果显示差异均有统计学意义(t=15.337~27.862,均P<0.001)。探索性因素分析示SQSS可分为4个维度,验证性因素分析示SQSS的4因子结构模型拟合良好,卡方/自由度(χ^(2)/df)为5.79,拟合优度系数(GFI)为0.94,近似误差均方根(RMSEA)为0.06,均方根残差(RMR)为0.03,比较拟合指数(CFI)为0.93,规范拟合指数(NFI)为0.92,不规范拟合指数(NNFI)为0.92,Tucker-Lewis指数(TLI)为0.92;SQSS的Cronbach'sα系数为0.92,分半信度系数为0.90;SQSS总分和WI-7、PHQ-9、GAD-7得分均呈正相关(r=0.67、0.68、0.61;均P<0.01)。以SQSS 29分为划界分,功能性躯体症状在普通居民中的检出率为10.28%(149/1450)。功能性躯体症状检出阳性者中女性、有精神疾病者、有慢性躯体疾病者占比更高(χ^(2)=5.12、29.90、34.08;均P<0.05),检出阳性者的SQSS、GAD-7、PHQ-9、WI-7得分高于阴性者(Z=20.03、14.51、13.03、15.27,均P<0.001)。结论SQSS具有较好的效度和信度,可用于在普通人群中进行功能性躯体症状的自我筛查。在中国普通居民中,功能性躯体症状检出率较高。

Objective To evaluate the validity and reliability of the Self-screening Questionnaire for Somatoform Symptoms(SQSS)among Chinese residents,and analyze the characteristics of participants with functional somatic symptoms.Methods From February to March 2020,convenience sampling was used to send the General Information Questionnaire,SQSS,Generalized Anxiety Disorder 7-Item Scale(GAD-7),9-item Patient Health Questionnaire(PHQ-9),and 7-item Whitely Index(WI-7)to Chinese residents through Wenjuanxing.Two weeks later,100 participants were selected using a random number table method for retesting of SQSS.Item analysis was carried out by correlation analysis between item scores and total scores of the scale and extreme group test.Validity was tested through exploratory factor analysis,confirmatory factor analysis.Reliability was tested by internal consistency Cronbach'sαcoefficient,split half reliability coefficient,and retest correlation coefficient.Chi square test and t-test were used to compare general and clinical data of participants with and without functional somatic symptoms.Results A total of 1506 questionnaires were collected,56 invalid questionnaires were excluded and 1450(96.3%)subjects were included.Item analysis of SQSS showed that the scores of each item were positively correlated with the total score of the scale,and the difference was statistically significant(r=0.49 to 0.70,all P<0.001).The discrimination analysis of each item showed statistically significant differences(t=15.337 to 27.862,all P<0.001).Exploratory factor analysis showed that the SQSS scale could be divided into four dimensions.Confirmatory factor analysis showed that the 4-factor structural model of SQSS fitted well,with a chi square/degree of freedom(χ^(2)/df)of 5.79,a goodnessof-fit index(GFI)of 0.94,root mean square error Approximation(RMSEA)of 0.06,root mean square residual(RMR)of 0.03,comparative fit index(CFI)of 0.93,normed fit index(NFI)of 0.92,non-normed fit index(NNFI)of 0.92,and Tucker Lewis index(TLI)of 0.92.The Cronbach'sαcoefficient of SQSS was 0.92,and the split half reliability coefficient was 0.90.The total score of SQSS was positively correlated with the scores of WI-7,PHQ-9,and GAD-7,and the differences were statistically significant(r=0.67,0.68,0.61;all P<0.01).The detection rate of functional somatic symptoms among ordinary residents was 10.28%(149/1450)based on the 29 points of the SQSS scale as the cut-off point.Among the patients with positive functional somatic symptoms,there were more females,those with mental illness,and those with chronic somatic diseases(χ^(2)=5.12,29.90,34.08;all P<0.05),and the SQSS,GAD-7,PHQ-9,and WI-7 scores of individuals with functional somatic symptoms were higher than those of the negative individuals(Z=20.03,14.51,13.03,15.27;all P<0.001),and the differences were statistically significant.Conclusions The SQSS has good validity and reliability,and can be used for functional somatic symptom self-screening in the general population.The detection rate of functional somatic symptoms is relatively high among ordinary Chinese residents.