CAJ | 학술논문

目的评估9条目患者健康问卷(PHQ-9)以及2条目患者健康问卷(PHQ-2)在心血管门诊患者中抑郁障碍筛查的信度和效度.方法 2013年6月至2014年1月于重庆医科大学附属第一医院和北京大学人民医院双心门诊连续纳入的201例患者作为研究对象.患者自主完成pHQ-9问卷,并根据精神疾病诊断与统计手册-Ⅳ轴Ⅰ障碍临床定式访谈(CIDI)进行心理状态评估.1周后,采用随机数字表法选择50例检验PHQ-9问卷的重测信度.以CIDI作为诊断标准,评估PHQ-2和PHQ-9内容效度.结果根据CIDI诊断标准,纳入对象中42例(21.3％)被诊断为临床抑郁.以10分为诊断界值,PHQ-9诊断抑郁的敏感度和特异度分别为87.1％和83.5％,阳性预测值和阴性预测值分别为58.7％和95.6％,ROC曲线下面积(AUC)为0.877(SE=0.032,95％ CI:0.813 ～0.938),内部一致性系数为0.809,重测信度系数为0.882.以3分为诊断界值,PHQ-2诊断抑郁的灵敏度和特异度分别是85.7％与69.2％,阳性预测值和阴性预测值分别为57.7％为93.6％,AUC为0.806(SE=0.042,95％CI:0.774 ～0.889),内部一致性系数为0.785,重测信度系数为0.813.结论 PHQ-2和PHQ-9是心血管门诊患者中抑郁障碍可靠和有效的筛查工具,有较高的排除诊断价值,值得在心血管门诊患者中推广应用.
목적 평고9조목환자건강문권(PHQ-9)이급2조목환자건강문권(PHQ-2)재심혈관문진환자중억욱장애사사적신도화효도.방법 2013년6월지2014년1월우중경의과대학부속제일의원화북경대학인민의원쌍심문진련속납입적201례환자작위연구대상.환자자주완성pHQ-9문권,병근거정신질병진단여통계수책-Ⅳ축Ⅰ장애림상정식방담(CIDI)진행심리상태평고.1주후,채용수궤수자표법선택50례검험PHQ-9문권적중측신도.이CIDI작위진단표준,평고PHQ-2화PHQ-9내용효도.결과 근거CIDI진단표준,납입대상중42례(21.3％)피진단위림상억욱.이10분위진단계치,PHQ-9진단억욱적민감도화특이도분별위87.1％화83.5％,양성예측치화음성예측치분별위58.7％화95.6％,ROC곡선하면적(AUC)위0.877(SE=0.032,95％ CI:0.813 ～0.938),내부일치성계수위0.809,중측신도계수위0.882.이3분위진단계치,PHQ-2진단억욱적령민도화특이도분별시85.7％여69.2％,양성예측치화음성예측치분별위57.7％위93.6％,AUC위0.806(SE=0.042,95％CI:0.774 ～0.889),내부일치성계수위0.785,중측신도계수위0.813.결론 PHQ-2화PHQ-9시심혈관문진환자중억욱장애가고화유효적사사공구,유교고적배제진단개치,치득재심혈관문진환자중추엄응용.
Objective To analyze the value of 2-and 9-question patient health questionnaires (PHQ-2 and PHQ-9) for screening status of depression in cardiovascular outpatients.Methods From June 2013 to January 2014,a total of 201 outpatients from psycho-cardiological outpatients departments were consecutively enrolled into this study.All patients were asked to complete PHQ-9 and the mental psychological assessment by qualified researchers trained by psychiatry according to the composite international diagnostic interviews (CIDI),50 cases were retested to assess the retest reliability after one week.The PHQ-2 and PHQ-9 were validated with the CIDI as the reference criteria.Results According to the CIDI,42(21.3％) out of the 201 outpatients were diagnosed as depression.For PHQ-9 scale,a cutoff value of 10 presented satisfactory results with 87.1％ sensitivity,83.5％ specificity,58.7％ positive predicting value,95.6％ negative predicting value and the area under the ROC curve (AUC) was 0.877 (SE =0.032,95％ CI:0.813-0.938).The Cronbach's alpha coefficients and test-retest reliability of the PHQ-9 were 0.809 and 0.882,respectively.Compared with CIDI,the cutoff value of the PHQ-2 was 3 with 85.7％ sensitivity,69.2％ specificity,57.1％ positive predicting value,93.6％ negative predicting value,and the AUC was 0.806(SE =0.042,95％ CI:0.774-0.889).The Cronbach's alpha coefficients and testretest reliability of the PHQ-2 were 0.785 and 0.813,respectively.Conclusion The PHQ-2 and PHQ-9 are reliable and efficient instruments for screening and especially excluding depression in cardiovascular outpatients.