《慢性阻塞性肺疾病（COPD）患者抑郁焦虑压力量表 21 版（DASS-21）的有效性和反应性》。
Validity and Responsiveness of the Depression Anxiety Stress Scales-21 (DASS-21) in COPD.
机构信息
Department of Physical Therapy, Azusa Pacific University, Azusa, CA.
Lytham St. Annes Primary Care Centre, Lancashire, UK.
出版信息
Chest. 2019 Jun;155(6):1166-1177. doi: 10.1016/j.chest.2018.12.010. Epub 2018 Dec 27.
BACKGROUND
We examined the validity and responsiveness of the Depression Anxiety and Stress Scales-21 (DASS-21) in patients with COPD following an 8-week pulmonary rehabilitation program (PRP).
METHODS
Five hundred and fifty-seven patients with clinically stable COPD completed an 8-week outpatient multidisciplinary PRP, comprising 2 h (1 h of exercise and 1 h of education) per week. Anxiety, exercise capacity, quality of life, and dyspnea were measured pre- and post-PRP, utilizing the Anxiety Inventory for Respiratory Disease, Incremental Shuttle Walk Test, St. George's Respiratory Questionnaire, and modified Medical Research Council dyspnea scale, respectively. In addition, we administered the DASS-21 to assess both the validity and responsiveness of this tool compared with other, well-established metrics.
RESULTS
The mean (SD) age of participants was 71.6 (9.4) years, and 49% were women. The DASS-21 reflected responsiveness to pulmonary rehabilitation. Among participants with a high depression score (> 9), the depression subscale score fell from 18.62 pre-PRP to 13.12 post-PRP (P < .001). Similarly, among participants with a high anxiety score (> 7), the anxiety subscale fell from 14.60 pre-PRP to 10.99 post-PRP (P < .001). Likewise, among participants with a high stress score (> 14), the stress subscale score fell from 23.51 pre-PRP to 16.34 post-PRP (P < .001). Among these subsamples, the effect size was medium at 0.49 for depression and 0.54 for anxiety, and large at 0.81 for stress. The change in DASS-21 subset (depression, anxiety, and stress) correlated with the change in total SGRQ score, at P < .001.
CONCLUSIONS
The DASS-21 has acceptable validity and is a responsive scale for use in PRP in patients with COPD.
背景
我们研究了在接受 8 周肺康复计划（PRP）后，慢性阻塞性肺疾病（COPD）患者的抑郁、焦虑和压力量表-21（DASS-21）的有效性和反应性。
方法
557 名临床稳定的 COPD 患者完成了为期 8 周的门诊多学科 PRP，每周 2 小时（1 小时运动和 1 小时教育）。分别使用呼吸疾病焦虑量表、递增穿梭步行测试、圣乔治呼吸问卷和改良医学研究委员会呼吸困难量表，在 PRP 前后测量焦虑、运动能力、生活质量和呼吸困难。此外，我们还使用 DASS-21 评估了该工具与其他成熟指标的有效性和反应性。
结果
参与者的平均（SD）年龄为 71.6（9.4）岁，49%为女性。DASS-21 反映了对肺康复的反应性。在抑郁评分较高（>9）的参与者中，抑郁分量表评分从 PRP 前的 18.62 下降到 PRP 后的 13.12（P<0.001）。同样，在焦虑评分较高（>7）的参与者中，焦虑分量表从 PRP 前的 14.60 下降到 PRP 后的 10.99（P<0.001）。同样，在压力评分较高（>14）的参与者中，压力分量表评分从 PRP 前的 23.51 下降到 PRP 后的 16.34（P<0.001）。在这些亚样本中，抑郁的效应大小为 0.49，焦虑的效应大小为 0.54，压力的效应大小为 0.81。DASS-21 亚组（抑郁、焦虑和压力）的变化与 SGRQ 总分的变化相关，P<0.001。
结论
DASS-21 具有可接受的有效性，是 COPD 患者 PRP 中使用的敏感量表。
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