中国心理卫生杂志

目的:了解焦虑自评量表(SAS)和自评抑郁量表(SDS)对非精神病性障碍的门诊患者与无精神障碍的陪伴者的区分效度,以及自评量表等级与医生采用常用工具得出症状严重程度的一致性。方法:在精神科门诊收集非精神病性障碍的初诊患者67例(病例组,其中神经症组42例,抑郁组25例),陪伴患者就诊的无精神障碍亲属29例(对照组),诊断由精神科医生按国际疾病和相关健康问题分类第10版(ICD-10)标准做出。对照组按照简明国际神经精神访谈(M.I.N.I.)结果除外存在精神障碍。然后请患者及对照组家属独立填写SAS和SDS,并由另一位精神科医生采用汉密顿焦虑量表(HAMA)和抑郁量表(HAMD)评定患者的症状程度。结果:病例组SAS及SDS得分均高于对照组[(41.5±9.0)vs.(33.6±6.7);(46.5±10.3)vs.(35.9±9.7);均P<0.001]。SAS与SDS的ROC工作曲线下面积均<0.7;采用40分为划界值,敏感度和特异度均不理想(如SAS敏感度仅为57%;SDS特异度只有36%)。若抽取其中更敏感的8个条目,可以使ROC工作曲线下面积达到0.8以上。无论是神经症组还是抑郁组,SAS等级与医生用HAM A得出的严重程度、SDS等级与用HAM D得出的症状程度,一致性不高,Kappa均为0.3左右。结论:采用SAS和SDS区分非精神病性障碍就诊者和一般陪诊家属效度不好,若用于筛查目的,可以从中抽取敏感性更强的条目组合为更简便的工具。自评量表得出的程度不能直接等同于医生评定的临床症状严重程度,若用于标定临床症状程度,需要调整界值。

Objective:To find out if the Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS)have differential validity among psychiatric outpatients without psychotic symptoms and their partners,as well as the consistency between the result of self-rating and that of professional assessment.Method:Sixty-seven psychiatric outpatients without psychotic symptoms(patient group) and 29 partners without mental disorder(control group) were collected.The diagnoses of patients were made according to the International Statistical Classification of Disease and Related Health Problems,Tenth Revision(ICD-10)criteria by one of the authors.The patients and the partners were asked to fulfill SAS and SDS after clinical examination.Another psychiatrist assessed their anxiety and depression with the Hamilton Anxiety Scale(HAMA) and Hamilton Depression Scale(HAMD).Result:The patient group had higher scores than the control group in both SAS and SDS[(41.5±9.0) vs.(33.6±6.7);(46.5±10.3) vs.(35.9±9.7);Ps<0.001].But the areas under the ROC curve of both instruments were less than 0.7.There was no qualified sensitivity or specificity found for both SAS and SDS using the current cut-off points of 40.If the top 8 sensitive items were selected from SAS and SDS,the area under the ROC curve could reach 0.858.The consistencies between results of self-ratings and corresponding professional assessments(the scores of HAMD and HAMA) were poor(with kappa about 0.3) in both the neurotic group and the depressive group.Conclusion:The Self-rating Anxiety Scale and the Self-rating Depression Scale may be not qualified instruments for differentiating psychiatric non psychotic patients and their partners without mental disorder.Ranks of self-rating symptom severity are probably unequal to clinical severity assessed with professional instruments.