College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
Arch Phys Med Rehabil. 2010 Aug;91(8):1218-24. doi: 10.1016/j.apmr.2010.04.015.
To investigate the factor structure and predictive validity of somatic and nonsomatic depressive symptoms over the first 2.5 years after spinal cord injury (SCI) using the Patient Health Questionnaire-9 (PHQ-9).
Somatic and nonsomatic symptoms were assessed at baseline during inpatient hospitalization (average of 50 days after onset) and during 2 follow-ups (average of 498 and 874 days after onset).
Data were collected at a specialty hospital in the Southeastern United States and analyzed at a medical university. We performed time-lag regression between inpatient baseline and follow-up somatic and nonsomatic latent factors of the PHQ-9.
Adults with traumatic SCI (N=584) entered the study during inpatient rehabilitation.
Not applicable.
PHQ-9, a 9-item measure of depressive symptoms.
The inpatient baseline nonsomatic latent factor was significantly predictive of the nonsomatic (r=.40; P=.000) and somatic latent factors at the second follow-up (r=.29; P=.006), whereas the somatic factor at inpatient baseline did not significantly predict either factor. In contrast, when regressing latent factors between the 2 follow-ups, the nonsomatic factor predicted only the nonsomatic factor (r=.66; P=.002), and the somatic factor predicted only future somatic symptoms (r=.66; P=.000). In addition, the factor structure was not stable over time. Item analysis verified the instability of somatic items between inpatient baseline and follow-up and also indicated that self-harm at inpatient baseline was highly predictive of future self-harm.
Nonsomatic symptoms are better predictors of future depressive symptoms when first assessed during inpatient rehabilitation, whereas somatic symptoms become stable predictors only after inpatient rehabilitation. Self-harm (suicidal ideation) is the most stable symptom over time. Clinicians should routinely assess for suicidal ideation and use nonsomatic symptoms when performing assessments during inpatient rehabilitation.
使用患者健康问卷-9（PHQ-9）调查脊髓损伤（SCI）后最初 2.5 年内躯体和非躯体抑郁症状的因素结构和预测效度。
在住院期间（发病后平均 50 天）和 2 次随访（发病后平均 498 天和 874 天）时评估躯体和非躯体症状。
在美国东南部的一家专科医院收集数据，并在一所医科大学进行分析。我们在 PHQ-9 的住院基线和随访躯体和非躯体潜在因素之间进行了时间滞后回归。
在住院康复期间进入研究的成年人有创伤性 SCI（N=584）。
不适用。
PHQ-9，一种 9 项测量抑郁症状的量表。
住院基线时的非躯体潜在因素与第二次随访时的非躯体（r=.40；P=.000）和躯体潜在因素显著相关，而住院基线时的躯体因素与两者均无显著相关。相比之下，当在两个随访期之间对潜在因素进行回归时，非躯体因素仅预测非躯体因素（r=.66；P=.002），而躯体因素仅预测未来的躯体症状（r=.66；P=.000）。此外，因素结构随时间并不稳定。项目分析验证了躯体项目在住院基线和随访之间的不稳定性，也表明住院基线时的自伤高度预测未来的自伤。
当首次在住院康复期间评估时，非躯体症状是未来抑郁症状的更好预测指标，而躯体症状只有在住院康复后才成为稳定的预测指标。自我伤害（自杀意念）是随时间最稳定的症状。临床医生应常规评估自杀意念，并在住院康复期间进行评估时使用非躯体症状。
