Williams Ryan T, Heinemann Allen W, Neumann Holly Demark, Fann Jesse R, Forchheimer Martin, Richardson Elizabeth J, Bombardier Charles H
American Institutes for Research, Chicago, IL.
Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Arch Phys Med Rehabil. 2016 Jun;97(6):929-37. doi: 10.1016/j.apmr.2016.01.017. Epub 2016 Feb 6.
To compare the measurement properties and responsiveness to change of the Patient Health Questionnaire-9 (PHQ-9), the Hopkins Symptom Checklist-20 (HSCL-20), and the Hamilton Depression Rating Scale (HAM-D) in people with spinal cord injury (SCI) diagnosed with major depressive disorder (MDD).
Secondary analysis of depression symptoms measured at 6 occasions over 12 weeks as part of a randomized controlled trial of venlafaxine XR for MDD in persons with SCI.
Outpatient and community settings.
Individuals (N=133) consented and completed the drug trial. Eligibility criteria were age at least 18 years, traumatic SCI, and diagnosis of MDD.
Venlafaxine XR.
Patients completed the PHQ-9 and the HSCL-20 depression scales; clinical investigators completed the HAM-D and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) Dissociative Disorders, which was used as a diagnostic criterion measure.
All 3 instruments were improved with rating scale analysis. The HSCL-20 and the HAM-D contained items that misfit the underlying construct and that correlated weakly with the total scores. Removing these items improved the internal consistency, with floor effects increasing slightly. The HAM-D correlated most strongly with Structured Clinical Interview for DSM-IV Dissociative Disorders diagnoses. Improvement in depression was similar on all outcome measures in both treatment and control groups.
The psychometric properties of the revised depression instruments are more than adequate for routine use in adults with SCI and are responsive to clinical improvement. The PHQ-9 is the simplest instrument with measurement properties as good as or better than those of the other instruments and required the fewest modifications.
比较患者健康问卷-9（PHQ-9）、霍普金斯症状清单-20（HSCL-20）和汉密尔顿抑郁量表（HAM-D）在诊断为重度抑郁症（MDD）的脊髓损伤（SCI）患者中的测量属性及对变化的反应性。
作为文拉法辛缓释片治疗SCI患者MDD的随机对照试验的一部分，对12周内6次测量的抑郁症状进行二次分析。
门诊和社区环境。
133名个体同意并完成了药物试验。纳入标准为年龄至少18岁、创伤性SCI且诊断为MDD。
文拉法辛缓释片。
患者完成PHQ-9和HSCL-20抑郁量表；临床研究人员完成HAM-D和《精神障碍诊断与统计手册（第四版）》（DSM-IV）分离性障碍结构化临床访谈，后者用作诊断标准测量。
通过量表分析，所有3种工具均有改善。HSCL-20和HAM-D包含与潜在结构不匹配且与总分相关性较弱的项目。去除这些项目可提高内部一致性，地板效应略有增加。HAM-D与DSM-IV分离性障碍结构化临床访谈诊断的相关性最强。治疗组和对照组在所有结局指标上的抑郁改善情况相似。
修订后的抑郁工具的心理测量特性足以用于SCI成人患者的常规使用，且对临床改善有反应。PHQ-9是最简单的工具，其测量特性与其他工具相当或更好，且所需修改最少。
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