患者健康问卷焦虑抑郁量表：三项临床试验中的初步验证
Patient Health Questionnaire Anxiety and Depression Scale: Initial Validation in Three Clinical Trials.
作者信息
Kroenke Kurt, Wu Jingwei, Yu Zhangsheng, Bair Matthew J, Kean Jacob, Stump Timothy, Monahan Patrick O
机构信息
From the VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center (Kroenke, Bair, Kean), Indianapolis, Indiana; Departments of Medicine (Kroenke, Bair) and Physical Medicine and Rehabilitation (Kean), Indiana University School of Medicine, Indianapolis, Indiana; Regenstrief Institute, Inc (Kroenke, Bair, Kean), Indianapolis, Indiana; Department of Biostatistics, Indiana University (Wu, Yu, Stump, Monahan), Indianapolis, Indiana.
出版信息
Psychosom Med. 2016 Jul-Aug;78(6):716-27. doi: 10.1097/PSY.0000000000000322.
OBJECTIVE
We examine the reliability and validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)-which combines the nine-item Patient Health Questionnaire depression scale and seven-item Generalized Anxiety Disorder scale-as a composite measure of depression and anxiety.
METHODS
Baseline data from 896 patients enrolled in two primary-care based trials of chronic pain and one oncology-practice-based trial of depression and pain were analyzed. The internal reliability, standard error of measurement, and convergent, construct, and factor structure validity, as well as sensitivity to change of the PHQ-ADS were examined.
RESULTS
The PHQ-ADS demonstrated high internal reliability (Cronbach α values of .8 to .9) in all three trials. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety), and the estimated standard error of measurement was approximately 3 to 4 points. The PHQ-ADS showed strong convergent (most correlations, 0.7-0.8 range) and construct (most correlations, 0.4-0.6 range) validity when examining its association with other mental health, quality of life, and disability measures. PHQ-ADS cutpoints of 10, 20, and 30 indicated mild, moderate, and severe levels of depression/anxiety, respectively. Bifactor analysis showed sufficient unidimensionality of the PHQ-ADS score. PHQ-ADS change scores at 3 months differentiated (p < .0001) between individuals classified as worse, stable, or improved by a reference measure, providing preliminary evidence for sensitivity to change.
CONCLUSIONS
The PHQ-ADS may be a reliable and valid composite measure of depression and anxiety which, if validated in other populations, could be useful as a single measure for jointly assessing two of the most common psychological conditions in clinical practice and research.
TRIAL REGISTRATION
Clinicaltrials.gov Identifier: NCT00926588 (SCOPE); NCT00386243 (ESCAPE); NCT00313573 (INCPAD).
目的
我们检验患者健康问卷焦虑抑郁量表（PHQ - ADS）的信度和效度，该量表将九项患者健康问卷抑郁量表和七项广泛性焦虑障碍量表合并，作为抑郁和焦虑的综合测量指标。
方法
分析了896名患者的基线数据，这些患者参与了两项基于初级保健的慢性疼痛试验以及一项基于肿瘤学实践的抑郁与疼痛试验。检验了PHQ - ADS的内部信度、测量标准误、收敛效度、结构效度和因子结构效度，以及其对变化的敏感性。
结果
在所有三项试验中，PHQ - ADS均显示出较高的内部信度（克朗巴哈α值为0.8至0.9）。PHQ - ADS得分范围为0至48分（得分越高表明抑郁/焦虑越严重），估计测量标准误约为3至4分。在检验其与其他心理健康、生活质量和残疾测量指标的关联时，PHQ - ADS显示出较强的收敛效度（大多数相关性在0.7 - 0.8范围内）和结构效度（大多数相关性在0.4 - 0.6范围内）。PHQ - ADS的切点10、20和30分别表示轻度、中度和重度抑郁/焦虑水平。双因素分析表明PHQ - ADS得分具有足够的单维性。在3个月时，PHQ - ADS变化得分在被参考测量分类为病情恶化（更差）、稳定或改善的个体之间存在差异（p < .0001），为其对变化的敏感性提供了初步证据。
结论
PHQ - ADS可能是一种可靠且有效的抑郁和焦虑综合测量指标，如果在其他人群中得到验证，可作为临床实践和研究中联合评估两种最常见心理状况的单一测量指标。
试验注册
Clinicaltrials.gov标识符：NCT00926588（SCOPE）；NCT00386243（ESCAPE）；NCT00313573（INCPAD）。
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