Li Tao, Wei Jing, Fritzsche Kurt, Toussaint Anne Christin, Jiang Yinan, Cao Jinya, Zhang Lan, Zhang Yaoyin, Chen Hua, Wu Heng, Ma Xiquan, Li Wentian, Ren Jie, Lu Wei, Müller Anne-Maria, Leonhart Rainer
From the Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Li, Wei, Jiang, Cao), Beijing, China; Center for Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg (Fritzsche, Müller), Freiburg im Breisgau; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf (Toussaint), Hamburg, Germany; Mental Health Centre, West China Hospital, Sichuan University (Zhang); Department of Psychosomatic Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China (Zhang), Chengdu; Department of Psychological Medicine, Zhong Shan Hospital, Fudan University (Chen); Department of Psychosomatic Medicine, Tongji Hospital, School of Medicine, Tongji University (Wu); Department of Psychosomatic Medicine, Dongfang Hospital, School of Medicine, Tongji University (Ma), Shanghai; Department of Clinic Psychology, Wuhan Mental Health Center (Li), Wuhan; Department of Rehabilitation, General Hospital of Jincheng Anthracite Coal Mining Group Co Ltd (Ren), Jincheng; Department of Psychosomatic Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University (Lu), Beijing, China; Institute of Psychology, University of Freiburg (Leonhart), Freiburg im Breisgau, Germany.
Psychosom Med. 2020 Apr;82(3):337-344. doi: 10.1097/PSY.0000000000000786.
This study aimed to validate the Chinese version of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in an outpatient sample from Chinese general hospitals and to determine the diagnostic performance of the SSD-12 as a screening tool for somatic symptom disorder (SSD).
The Chinese version of the SSD-12 was completed by 699 outpatients from nine general hospitals during a 16-month period (2016-2018). The SSD section of the Structured Clinical Interview for DSM Disorders, Fifth Edition, Research Version, was used to determine diagnostic accuracy (criterion validity). The construct validity of the SSD-12 was evaluated by examining correlations with the Whiteley Index-7, Patient Health Questionnaire-15, Patient Health Questionnaire-9, General Anxiety Disorder-7, World Health Organization Disability Assessment Schedule, and Medical Outcome Study 12-item Short Form Health Survey (SF-12).
The SSD-12 had excellent internal consistency in this sample (Cronbach α = .95). Confirmatory factor analyses replicated a three-factor structure that reflects the cognitive, affective, and behavioral aspects (Comparative Fit Index = 0.963, Tucker-Lewis Index = 0.952, root mean square error of approximation = 0.08, 90% confidence interval = 0.08-0.09), but was also consistent with a general one-factor model of the SSD-12 (Comparative Fit Index = 0.957, Tucker-Lewis Index = 0.948, root mean square error of approximation = 0.09, 90% confidence interval = 0.08-0.10). The optimal cutoff point for the Structured Clinical Interview for DSM Disorders-based diagnosis of SSD was 16 (sensitivity = 0.76, specificity = 0.80). The SSD-12 sum score was significantly associated with somatic symptom burden (Patient Health Questionnaire-15: r = 0.52, p < .001), health anxiety (Whiteley Index-7: r = 0.82, p < .001), depressive symptoms (Patient Health Questionnaire-9: r = 0.63, p < .001), general anxiety (General Anxiety Disorder-7: r = 0.64, p < .001), health-related quality of life (physical component score of SF-12: r = -0.49, p < .001; mental component score of SF-12: r = -0.61, p < .001), and health-related disabilities (World Health Organization Disability Assessment Schedule: r = 0.56, p < .001).
Initial assessment indicates that the Chinese version of the SSD-12 has sufficient reliability and validity to warrant further testing in both research and clinical settings.
本研究旨在在中国综合医院门诊样本中验证中文版躯体症状障碍B标准量表（SSD - 12），并确定SSD - 12作为躯体症状障碍（SSD）筛查工具的诊断性能。
在16个月期间（2016 - 2018年），来自9家综合医院的699名门诊患者完成了中文版SSD - 12。使用《精神疾病诊断与统计手册》第五版研究版的结构化临床访谈中的SSD部分来确定诊断准确性（标准效度）。通过检查与惠特利指数 - 7、患者健康问卷 - 15、患者健康问卷 - 9、广泛性焦虑障碍 - 7、世界卫生组织残疾评估量表以及医学结果研究12项简短健康调查（SF - 12）的相关性，评估SSD - 12的结构效度。
在该样本中，SSD - 12具有出色的内部一致性（克朗巴哈α系数 = 0.95）。验证性因素分析重现了反映认知、情感和行为方面的三因素结构（比较拟合指数 = 0.963，塔克 - 刘易斯指数 = 0.952，近似均方根误差 = 0.08，90%置信区间 = 0.08 - 0.09），但也与SSD - 12的一般单因素模型一致（比较拟合指数 = 0.957，塔克 - 刘易斯指数 = 0.948，近似均方根误差 = 0.09，90%置信区间 = 0.08 - 0.10）。基于《精神疾病诊断与统计手册》的SSD诊断的结构化临床访谈的最佳截断点为16（敏感性 = 0.76，特异性 = 0.80）。SSD - 12总分与躯体症状负担（患者健康问卷 - 15：r = 0.52，p < 0.001）、健康焦虑（惠特利指数 - 7：r = 0.82，p < 0.001）、抑郁症状（患者健康问卷 - 9：r = 0.63，p < 0.001）、广泛性焦虑（广泛性焦虑障碍 - 7：r = 0.64，p < 0.001）、健康相关生活质量（SF - 12的身体成分得分：r = -0.49，p < 0.001；SF - 12的心理成分得分：r = -0.61，p < 0.001）以及健康相关残疾（世界卫生组织残疾评估量表：r = 0.56，p < 0.001）显著相关。
初步评估表明，中文版SSD - 12具有足够的信度和效度，值得在研究和临床环境中进行进一步测试。
