School of Medicine, Indiana University, Indianapolis, Indiana, USA.
J Pain Symptom Manage. 2013 Jan;45(1):71-82. doi: 10.1016/j.jpainsymman.2011.12.284. Epub 2012 Aug 22.
Although a number of depression measures have been used with cancer patients, longitudinal comparisons of several measures in the same patient population have been infrequently reported.
To compare the Hopkins Symptom Checklist 20-item depression scale, Short-Form 36 Mental Health Inventory five-item distress scale, and Patient Health Questionnaire nine-item depression scale in adults with cancer.
Of the 309 cancer patients enrolled in a telecare management trial for depression, 247 completed the three depression measures at both baseline and at three months and a retrospective assessment of global rating of change in depression at three months. Internal consistency and construct validity of each measure were evaluated. Responsiveness was compared by calculating standardized response means and receiver operating characteristic area under the curve, using global rating of change as the external comparator measure. Differences between intervention and control groups in depression change scores were compared by calculating standardized effect sizes (SESs).
Internal reliability coefficients for the three measures were ≥0.77 at baseline and ≥0.84 at three months. Construct validity was supported with strong correlations of the depression measures among themselves, moderately strong correlations with other measures of mental health, and moderate correlations with vitality and disability. In terms of responsiveness, standardized response means for all measures significantly differentiated between three groups (improved, unchanged, and worse) as classified by patient-reported global rating of change in depression at three months. The three measures were able to detect a modest treatment effect in the intervention group compared with the control group (SES ranging from 0.21 to 0.43) in the full sample, whereas detecting a greater treatment effect in depressed participants with comorbid pain (SES ranging from 0.30 to 0.58). Finally, the three measures performed similarly in detecting patients with improvement.
The Hopkins Symptom Checklist 20-item depression scale, Mental Health Inventory five-item distress scale, and Patient Health Questionnaire nine-item depression scale were established as reliable, valid, and responsive depression measures in adults with cancer. Given the current recommendations for measurement-based care, our study shows that clinicians treating depressed cancer patients have several measures from which to choose.
尽管已经有许多种抑郁评估工具应用于癌症患者，但在同一患者人群中对几种工具进行纵向比较的情况却很少有报道。
比较霍普金斯症状清单 20 项抑郁量表、简易 36 项健康调查量表心理健康成分五分制、患者健康问卷 9 项抑郁量表在癌症患者中的应用。
在一项针对癌症患者抑郁的远程护理管理试验中，共纳入 309 例癌症患者，其中 247 例患者在基线和 3 个月时完成了这 3 种抑郁评估工具的评估，并对 3 个月时抑郁的整体变化进行了回顾性评估。评估每种工具的内部一致性和结构效度。使用整体变化评分作为外部比较指标，计算标准化反应均值和受试者工作特征曲线下面积，比较各工具的反应度。通过计算抑郁变化评分的标准化效应量（SES）比较干预组和对照组之间的差异。
在基线时，3 种工具的内部可靠性系数均≥0.77，在 3 个月时均≥0.84。抑郁评估工具之间的相关性较强，与其他心理健康评估工具的相关性也较强，与活力和残疾的相关性适中，说明结构效度良好。在反应度方面，所有工具的标准化反应均值均能根据患者在 3 个月时的抑郁整体变化评分（分为改善、不变和恶化）将 3 组区分开来。与对照组相比，在整个样本中，这 3 种工具都能检测到干预组的适度治疗效果（SES 范围为 0.21-0.43），而在伴有共病性疼痛的抑郁患者中检测到的治疗效果更大（SES 范围为 0.30-0.58）。最后，这 3 种工具在检测改善的患者方面表现相似。
霍普金斯症状清单 20 项抑郁量表、简易 36 项健康调查量表心理健康成分五分制、患者健康问卷 9 项抑郁量表可作为癌症患者中可靠、有效和敏感的抑郁评估工具。鉴于目前对基于测量的护理的建议，我们的研究表明，治疗抑郁癌症患者的临床医生有多种工具可供选择。
