School of Social Work & Department of Psychiatry, Columbia University, New York, NY 10027, USA.
Depress Anxiety. 2012 Jul;29(7):652-64. doi: 10.1002/da.21949. Epub 2012 Apr 13.
Clinician-administered measures to assess severity of illness anxiety and response to treatment are few. The authors evaluated a modified version of the hypochondriasis-Y-BOCS (H-YBOCS-M), a 19-item, semistructured, clinician-administered instrument designed to rate severity of illness-related thoughts, behaviors, and avoidance.
The scale was administered to 195 treatment-seeking adults with DSM-IV hypochondriasis. Test-retest reliability was assessed in a subsample of 20 patients. Interrater reliability was assessed by 27 interviews independently rated by four raters. Sensitivity to change was evaluated in a subsample of 149 patients. Convergent and discriminant validity was examined by comparing H-YBOCS-M scores to other measures administered. Item clustering was examined with confirmatory and exploratory factor analyses.
The H-YBOCS-M demonstrated good internal consistency, interrater and test-retest reliability, and sensitivity to symptom change with treatment. Construct validity was supported by significant higher correlations with scores on other measures of hypochondriasis than with nonhypochondriacal measures. Improvement over time in response to treatment correlated with improvement both on measures of hypochondriasis and on measures of somatization, depression, anxiety, and functional status. Confirmatory factor analysis did not show adequate fit for a three-factor model. Exploratory factor analysis revealed a five-factor solution with the first two factors consistent with the separation of the H-YBOCS-M items into the subscales of illness-related avoidance and compulsions.
H-YBOCS-M appears to be valid, reliable, and appropriate as an outcome measure for treatment studies of illness anxiety. Study results highlight "avoidance" as a key feature of illness anxiety-with potentially important nosologic and treatment implications.
评估疾病焦虑严重程度和治疗反应的临床医生管理措施很少。作者评估了改良的疑病症-Y-BOCS（H-YBOCS-M），这是一种 19 项半结构化的临床医生管理工具，用于评估与疾病相关的思维、行为和回避的严重程度。
该量表被用于 195 名接受 DSM-IV 疑病症治疗的成年患者。在 20 名患者的子样本中评估了重测信度。通过由四名评估者独立评估的 27 次访谈评估了评分者间信度。在 149 名患者的子样本中评估了对变化的敏感性。通过与其他管理措施进行比较，检查 H-YBOCS-M 评分的聚合和判别有效性。使用验证性和探索性因子分析检查项目聚类。
H-YBOCS-M 表现出良好的内部一致性、评分者间和重测信度以及对治疗引起的症状变化的敏感性。结构有效性得到了支持，与其他疑病症测量得分的相关性显著高于与非疑病症测量得分的相关性。随着时间的推移，对治疗的反应改善与对疑病症和躯体化、抑郁、焦虑和功能状态的测量的改善相关。验证性因子分析显示三因子模型的拟合度不佳。探索性因子分析显示了一个五因子解决方案，前两个因子与 H-YBOCS-M 项目分为与疾病相关的回避和强迫两个子量表的分离一致。
H-YBOCS-M 似乎是一种有效的、可靠的、适合作为疾病焦虑治疗研究的结果测量工具。研究结果突出了“回避”作为疾病焦虑的一个关键特征——具有潜在重要的分类学和治疗意义。
