Thombs Brett D
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Burns. 2007 Aug;33(5):547-53. doi: 10.1016/j.burns.2006.10.398. Epub 2007 May 7.
The objective of this study was to assess whether scores on the Beck Depression Inventory (BDI) are biased by injury severity among hospitalized survivors of burn (N=262). A confirmatory factor analysis (CFA) model was developed with a general depression factor that loaded on all items and somatic and cognitive factors that were orthogonal to the general factor and to each other. The model fit the data well and substantially better than an alternative three-factor model with correlated factors. Percent total body surface area burned (TBSA) was significantly associated with the general depression factor (p=.04), but also with the orthogonal somatic factor (p<.001), suggesting biased measurement due to overlap between somatic symptoms of depression and the severity of the burn injury. Analysis of item communalities, however, suggested that only approximately 2% of total predicted item variance was associated with bias related to injury severity. It was concluded that, despite a small amount of bias, the BDI is a reasonably accurate clinical tool even in the context of severe burn. Appropriate adjustments for bias, however, should be made in research with the BDI among patients with acute burn.
本研究的目的是评估在烧伤住院幸存者（N = 262）中，贝克抑郁量表（BDI）的得分是否受到损伤严重程度的影响。我们构建了一个验证性因素分析（CFA）模型，该模型包含一个对所有项目都有载荷的一般抑郁因素，以及与该一般因素相互正交的躯体因素和认知因素。该模型与数据拟合良好，且显著优于一个具有相关因素的替代三因素模型。烧伤总面积（TBSA）百分比与一般抑郁因素显著相关（p = 0.04），但也与正交的躯体因素相关（p < 0.001），这表明由于抑郁的躯体症状与烧伤损伤严重程度之间的重叠，存在测量偏差。然而，对项目共同度的分析表明，在总预测项目方差中，只有约2%与损伤严重程度相关的偏差有关。研究得出结论，尽管存在少量偏差，但即使在严重烧伤的情况下，BDI仍是一种相当准确的临床工具。然而，在对急性烧伤患者进行BDI研究时，应针对偏差进行适当调整。
