HADS 和 PHQ-9 的项目差异功能：对英国临床初级保健样本中的年龄、性别和教育背景的调查。

Differential item functioning of the HADS and PHQ-9: an investigation of age, gender and educational background in a clinical UK primary care sample.

机构信息

Applied Medical Sciences (Psychiatry), University of Aberdeen, Clinical Research Centre, Royal Cornhill Hospital, Aberdeen, AB25 2ZH, United Kingdom.

出版信息

J Affect Disord. 2013 May;147(1-3):262-8. doi: 10.1016/j.jad.2012.11.015. Epub 2012 Dec 4.

DOI:10.1016/j.jad.2012.11.015

PMID:23218250

Abstract

BACKGROUND

The Patient Health Questionnaire (PHQ-9) and Hospital Anxiety and Depression Scale (HADS) are commonly used measures in clinical practice and research. It is important that such scales measure the trait they purport to measure and that the impact of other measurement artefacts is minimal. Differential item functioning of these scales by gender, educational background and age is currently assessed.

METHODS

Severity of depression and anxiety symptoms were measured in primary care patients referred to mental health workers using the PHQ-9 and HADS. Each scale was assessed for Differential Item Functioning (DIF) and Differential Test Function (DTF) by gender, educational background and age. Minimum n per analysis=895. DIF was assessed with Mantel's χ(2), Liu-Agresti cumulative common odds ratio (LA LOR) and the standardised LA LOR (LA LOR-Z). DTF was assessed in relation to ν(2).

RESULTS

PHQ-9, HADS Depression Sub-scale (HADS-D) and HADS Anxiety Subscale (HADS-A) lacked bias in terms of gender and educational background (ν(2)<0.07). However, both PHQ-9 and HADS-D exhibited bias with regard to age: PHQ-9 ν(2)=0.103 (medium effect); HADS-D ν(2)=0.214 (large effect). PHQ-9 items exhibiting DIF by age covered: anhedonia, energy and low mood. HADS-D items exhibiting DIF by age covered psychomotor retardation and interest in appearance.

LIMITATIONS

No assessment of other potential DIF contributors was made.

CONCLUSIONS

PHQ-9, HADS-D and HADS-A generally do not exhibit bias for gender and educational background. However bias was observed in PHQ-9 and HADS-D for age. Caution should be exercised interpreting scores both in clinical practice and research.

摘要

背景

患者健康问卷（PHQ-9）和医院焦虑抑郁量表（HADS）是临床实践和研究中常用的测量工具。这些量表重要的是要测量其声称要测量的特质，并且其他测量 artefacts 的影响最小。目前正在评估这些量表在性别、教育背景和年龄方面的差异项目功能。

方法

使用 PHQ-9 和 HADS 对转诊至心理健康工作者的初级保健患者进行抑郁和焦虑症状严重程度的测量。根据性别、教育背景和年龄评估每个量表的差异项目功能（DIF）和差异测试功能（DTF）。每种分析的最小 n=895。使用 Mantel 的 χ(2)、Liu-Agresti 累积共同优势比（LA LOR）和标准化 LA LOR（LA LOR-Z）评估 DIF。评估 DTF 与 ν(2)的关系。

结果

PHQ-9、HADS 抑郁分量表（HADS-D）和 HADS 焦虑分量表（HADS-A）在性别和教育背景方面没有偏差（ν(2)<0.07）。然而，PHQ-9 和 HADS-D 都在年龄方面存在偏差：PHQ-9 ν(2)=0.103（中等效应）；HADS-D ν(2)=0.214（大效应）。年龄导致 PHQ-9 项目出现差异的项目包括快感缺失、精力和情绪低落。年龄导致 HADS-D 项目出现差异的项目包括精神运动迟缓以及对外观的兴趣。