Nilges P, Essau C
DRK Schmerz-Zentrum, Auf der Steig 14, 55131, Mainz, Deutschland.
Department of Psychology, University of Roehampton, London, England.
Schmerz. 2015 Dec;29(6):649-57. doi: 10.1007/s00482-015-0019-z.
The assessment of mental distress is a central aspect in pain research and treatment. Particularly for depression the comorbidity with pain poses methodological and conceptual challenges. This study examined the psychometric properties of the short version of the depression, anxiety and stress scale (DASS), used in both pain research and treatment and constructed to overcome the particular problems by omitting somatic items and concentrating on the psychological core aspects of depression, anxiety and stress.
The psychometric properties of the DASS-21 were compared between patients with pain and various people without any pain problems (N = 950). The DASS has three subscales, depression, anxiety and stress, each with seven items. The construct validity of the DASS was examined using the hospital anxiety and depression scale (HADS) for anxiety and depression and the general depression scale (Allgemeine Depressionsskala, ADS) for depression. The sensitivity and specificity for depression were determined against a structured interview for diagnostic and statistical manual of mental disorders (DSM-IV) and compared with the Center for Epidemiological Studies depression scale (CESD) and HADS in pain patients.
Cronbach's alpha of the DASS for the depression subscale was at least 0.91, while the anxiety and stress subscales had Cronbach alphas of 0.78-0.82 and 0.81-0.89, respectively. Although the depression subscale has only 7 items, it is just as reliable as the ADS with 21 items. It also has a better sensitivity and specificity than the HADS in identifying clinical patients with depression.
The DASS is a reliable questionnaire, free to use and brief to administer; therefore, it is an alternative to the previously used instruments for the screening of depression. Furthermore, the subscale stress measures irritability and tension, which are important aspects of pain experience but underused in assessment procedures for the diagnosis and treatment evaluation of patients with pain.
心理困扰评估是疼痛研究与治疗的核心内容。尤其是抑郁症，其与疼痛的共病给方法学和概念界定带来了挑战。本研究考察了抑郁、焦虑和压力量表简版（DASS）的心理测量特性，该量表在疼痛研究与治疗中均有应用，旨在通过省略躯体项目并聚焦于抑郁、焦虑和压力的心理核心方面来克服特定问题。
比较了疼痛患者与各类无疼痛问题人群（N = 950）之间DASS - 21的心理测量特性。DASS有三个分量表，即抑郁、焦虑和压力，每个分量表各有七个项目。使用医院焦虑抑郁量表（HADS）评估焦虑和抑郁，使用一般抑郁量表（Allgemeine Depressionsskala，ADS）评估抑郁，以此检验DASS的结构效度。针对精神障碍诊断与统计手册（DSM - IV）结构化访谈确定抑郁的敏感性和特异性，并与疼痛患者的流行病学研究中心抑郁量表（CESD）和HADS进行比较。
DASS抑郁分量表的克朗巴哈系数至少为0.91，而焦虑和压力分量表的克朗巴哈系数分别为0.78 - 0.82和0.81 - 0.89。尽管抑郁分量表仅有7个项目，但与有21个项目的ADS一样可靠。在识别临床抑郁症患者方面，其敏感性和特异性也优于HADS。
DASS是一种可靠的问卷，免费使用且易于施测；因此，它是先前用于筛查抑郁症的工具的替代选择。此外，压力分量表测量易怒和紧张情绪，这些是疼痛体验的重要方面，但在疼痛患者的诊断和治疗评估程序中未得到充分利用。
