Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
Department of Psychiatry, Affiliated Hospital of Southwest Medical University, Luzhou, China.
BMJ Open. 2020 Jul 13;10(7):e033211. doi: 10.1136/bmjopen-2019-033211.
To evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis.
Cross-sectional study.
Tertiary care centre.
Patients with psoriasis who have not been diagnosed with depression (n=148; mean age 43.37±17.46 years; 31.19% female).
The primary outcome measures considered in this study were the C-PHQ-9 and the Hamilton Depression Scale (HAMD). The American Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) was used as the gold standard for the diagnosis of depression. Cronbach's α and test-retest reliability after 1 week were evaluated using reliability analysis, and criterion and structural validity were assessed using validity analysis. Receiver operating characteristic (ROC) analysis was performed to identify the best demarcation score and diagnostic accuracy.
Compared with DSM-V (27.27%), both C-PHQ-9 (39.19%) and HAMD (31.01%) had higher rates for detecting depression. The mean completion time for C-PHQ-9 evaluation (2.02±0.84 min) was significantly less than that for HAMD (23.37±3.21 min, p<0.001). The Cronbach's α coefficient for the C-PHQ-9 was 0.938. The correlation coefficients of the nine items with the total scale ranged from 0.540 to 0.854, and the mean inter-item correlation coefficients ranged from 0.376 to 0.933. After a week, the retest coefficient was 0.955 (p<0.01). Principal component factor analysis showed that C-PHQ-9 identified a unifactorial structure. The best cut-off point was 9 points, with a sensitivity of 98.00% and a specificity of 90.80%. The area under the ROC curve was 0.979 (95% CI 0.968 to 0.991).
C-PHQ-9 has good reliability and validity in patients with psoriasis and can be used for primary screening of patients with psoriasis and depression. This scale has obvious time and labour advantages over the HAMD and should be considered for use in clinical practice.
评估中文版患者健康问卷-9（C-PHQ-9）在银屑病患者中的临床信度和效度。
横断面研究。
三级保健中心。
未被诊断为抑郁症的银屑病患者（n=148；平均年龄 43.37±17.46 岁；31.19%为女性）。
本研究的主要结局指标是 C-PHQ-9 和汉密尔顿抑郁量表（HAMD）。《精神障碍诊断与统计手册第五版》（DSM-V）被用作抑郁症诊断的金标准。采用可靠性分析评估克朗巴赫α和 1 周后重测信度，采用效度分析评估效标和结构效度。采用受试者工作特征（ROC）分析确定最佳分界评分和诊断准确性。
与 DSM-V（27.27%）相比，C-PHQ-9（39.19%）和 HAMD（31.01%）检测出抑郁症的比例均更高。C-PHQ-9 评估的平均完成时间（2.02±0.84 分钟）显著短于 HAMD（23.37±3.21 分钟，p<0.001）。C-PHQ-9 的克朗巴赫α系数为 0.938。九个项目与总量表的相关系数范围为 0.540 至 0.854，平均项目间相关系数范围为 0.376 至 0.933。1 周后复测系数为 0.955（p<0.01）。主成分因子分析显示，C-PHQ-9 可识别出单因素结构。最佳截断点为 9 分，灵敏度为 98.00%，特异性为 90.80%。ROC 曲线下面积为 0.979（95%CI 0.968 至 0.991）。
C-PHQ-9 在银屑病患者中具有良好的信度和效度，可用于银屑病患者和抑郁症的初步筛查。该量表在时间和劳动力方面明显优于 HAMD，应考虑在临床实践中使用。
