开发并对用于评估初级保健中抑郁的问卷进行心理计量学评估：一项横断面研究。

Development and psychometric evaluation of a questionnaire for the assessment of depression in primary care: a cross-sectional study.

机构信息

Institute of General Practice and Health Services Research, Department of Clinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany

Department Psychology, LMU Munich, Munich, Germany.

出版信息

BMJ Open. 2024 Jul 16;14(7):e084102. doi: 10.1136/bmjopen-2024-084102.

DOI:10.1136/bmjopen-2024-084102

PMID:39013641

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11253771/

Abstract

OBJECTIVES

To develop a new questionnaire for the diagnostic assessment of depression adapted to the primary care setting by combining psychiatric criteria and heuristics of general practitioners (GPs). Psychometric evaluation of the new questionnaire and first validity evidence.

DESIGN

The questionnaire was developed using cognitive interviews with think-aloud technique. Factorial validity was then examined in a cross-sectional study.

SETTING

Primary care. Five general practices in Bavaria, Germany.

PARTICIPANTS

15 GPs, 4 psychiatrists/psychotherapists and 13 patients participated in cognitive expert interviews. A primary care sample of N=277 consecutive patients participated in the cross-sectional study.

METHODS

After consultation with experts and literature research, the questionnaire contained a self-rating part for patients and an external part for GPs. Items were then iteratively optimised using cognitive interviews. Factorial validity was examined. To estimate internal consistency, Cronbach's α was calculated. Validity was assessed by correlating the new questionnaire and the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

The preliminary version of the two-part 'Questionnaire for the assessment of DEpression SYmptoms in Primary Care' (DESY-PC) comprised 52 items for patients (DESY-PAT-1: questions about patient's environment; DESY-PAT-2: questions about depression-specific symptoms) and 21 items for GPs (DESY-GP). The analysis of the DESY-PAT-1 revealed a one-factor solution ('environmental factors') with Cronbach's α of 0.55. The items of the DESY-PAT-2 were assigned to three factors, 'depressive cognitions', 'suicidality' and 'symptoms of fatigue', with Cronbach's α of 0.86, 0.79 and 0.85, respectively. Factorial analysis revealed two factors for the DESY-GP: 'depression symptoms' and 'medical history/external factors'. Cronbach's α was 0.90 and 0.59, respectively. After factorial analysis, the DESY-PAT was reduced to 28 items, and the DESY-GP was reduced to 15 items. Correlations of the DESY-PC with the PHQ-9 were high and significant, indicating convergent validity.

CONCLUSIONS

The new questionnaire represents an innovative extension of depression questionnaires and could be particularly suitable for general practices.

摘要

目的

通过结合精神科标准和全科医生的启发式方法，为初级保健环境中的抑郁症诊断评估开发一种新的问卷。新问卷的心理测量评估和初步有效性证据。

设计

使用认知访谈和出声思维技术开发问卷。然后在横断面研究中检查因子有效性。

设置

初级保健。德国巴伐利亚州的五家全科诊所。

参与者

15 名全科医生、4 名精神科医生/心理治疗师和 13 名患者参加了认知专家访谈。一项针对 N=277 名连续患者的横断面研究。

方法

在与专家协商和文献研究后，问卷包含患者的自我评估部分和全科医生的外部部分。然后使用认知访谈迭代优化项目。检查因子有效性。为了估计内部一致性，计算了 Cronbach's α。通过与患者健康问卷-9（PHQ-9）相关联来评估有效性。

结果

两部分“初级保健中抑郁症状评估问卷”（DESY-PC）的初步版本包含 52 项患者问题（DESY-PAT-1：关于患者环境的问题；DESY-PAT-2：关于抑郁特异性症状的问题）和 21 项全科医生问题（DESY-GP）。DESY-PAT-1 的分析显示了一个单因素解决方案（“环境因素”），Cronbach's α 为 0.55。DESY-PAT-2 的项目被分配到三个因素，“抑郁认知”、“自杀意念”和“疲劳症状”，Cronbach's α 分别为 0.86、0.79 和 0.85。因子分析显示 DESY-GP 有两个因素：“抑郁症状”和“病史/外部因素”。Cronbach's α 分别为 0.90 和 0.59。因子分析后，DESY-PAT 减少到 28 项，DESY-GP 减少到 15 项。DESY-PC 与 PHQ-9 的相关性较高且显著，表明具有收敛有效性。