本文選題：精神障礙　切入點：篩查量表　出處：《福建醫(yī)科大學》2012年碩士論文

【摘要】：目的：精神障礙流行病學結果取決于篩查量表的功能及診斷工具。專業(yè)的精神科或心身科門診，以及非專業(yè)的心理咨詢工作室乃至人才測評領域，均迫切需要簡短有效的篩查量表，而國內外精神障礙的篩查問卷為數(shù)不多，如GHQ-12或SRQ-24也只能對軸I的部分病種有鑒別力，特別是智力因子很難用問卷法檢出。為此，本研究試圖改變測量學策略，編制新的比GHQ-12更廣譜的精神障礙篩查量表。 方法：經(jīng)過3個試用版的臨床病人初試，新編33條SSDM初始問卷，加上GHQ12條目，在心身科門診采集1554例各種隨機病人及208例正常人，共有效樣本1355例。多元統(tǒng)計分析了SSMD及GHQ-12的因子構成、條目分析后確定劃界分，比較兩套量表的信度、ROC曲線等。 結果： 1.因子分析發(fā)現(xiàn)SSMD有20個獨立的因子，解釋總方差的80.323%，其中18個因子有癥狀掃描價值，包括了智能和人格障礙兩個重要因子。GHQ-12只有3個因子，解釋總方差67.680%，且多數(shù)條目不具有臨床價值。SSMD與GHQ-12量表在抑郁因子上有少部分共同因子負荷。 2.條目分析結果顯示SSMD只有2個條目不具有臨床價值，再減去K條目1條，，保留30個條目，對不同病種的正答率高于GHQ-12。探索了篩查量表全新的條目設計技術，SSMD條目設計還可以再優(yōu)化。 3. SSMD的Cronbach's Alpha系數(shù)為0.910，與GHQ-12的系數(shù)0.917相當。SSMD與GHQ-12總分的Spearman相關等級相關系數(shù)為0.816。 4.開創(chuàng)了臨床法與統(tǒng)計學結合的劃界方法：找出正常人與病人的分布圖交叉點，剔除正常人中的潛在病人，ROC分析找出靈敏度特異度最合理的分界值。 5.ROC分析：SSMD以6分為初步劃界分，其SSMD的靈敏度為94.6%，特異度為89.1%，假陰性率為5.4%，假陽性率為10.9%；GHQ-12以4為劃界分的靈敏度為87.7%，特異度為79.8%，假陰性率為12.3%，假陽性率為20.2%。SSMD的靈敏度與特異度均高于GHQ-12，而假陰性率與假陽性率均低于GHQ-12。漏診率明顯低于GHQ-12。 結論： 1. SSMD以最少的題目獲得目前最多的診斷學因子； 2. SSMD的內部一致性信度與GHQ-12相當，SSMD的靈敏度，特異度比GHQ-12高；其假陰性率與假陽性率均低于GHQ-12�？傮w效度明顯優(yōu)于GHQ-12。達到最高的篩查量表的心理測驗學技術水平。 3. SSMD劃界分為6分；GHQ-12為4分。 4.開創(chuàng)了全新的臨床法與測量學相結合的正常-異常劃界分方法。 5.探索了篩查量表條目設計的新技術；SSMD的條目表述和因子構成還可以進一步完善改進。 6.我們心理衛(wèi)生門診應用說明，SSMD的癥狀掃描范圍超過高年資的精神�？漆t(yī)生的個人經(jīng)驗，也優(yōu)于多數(shù)臨床病人的自主表達能力，且與病情及療效直接相關。
[Abstract]:Objective: the epidemiological results of mental disorders depend on the function and diagnostic tools of the screening scale, specialized psychiatric or psychosomatic outpatient clinics, non-professional psychological counseling workshops and even the field of talent evaluation. There is an urgent need for short and effective screening scales, and there are few screening questionnaires for mental disorders at home and abroad. For example, GHQ-12 or SRQ-24 can only identify some of the diseases of axis I, especially the intelligence factor is difficult to detect by questionnaire. This study attempts to change measurement strategies and develop a new screening scale for mental disorders that is broader than GHQ-12. Methods: after the first trial of 3 trial versions of clinical patients, 33 new SSDM initial questionnaires and GHQ12 items, 1554 random patients and 208 normal subjects were collected in psychosomatic outpatient clinic. The factor composition of SSMD and GHQ-12 was analyzed by multivariate statistical analysis, the demarcation score was determined after item analysis, and the reliability of the two sets of scales was compared. Results:. 1. Factor analysis showed that SSMD had 20 independent factors, which accounted for 80.32323 of the total variance, 18 of which had symptomatic scanning value, including two important factors of intelligence and personality disorder. GHQ-12 had only 3 factors. Explain total variance 67.680 and most items have no clinical value. SSMD and GHQ-12 scale have a few common factor loads on depression factors. 2. Item analysis showed that only 2 items in SSMD had no clinical value. The positive response rate for different diseases was higher than that for GHQ-12. A new item design technique for screening scale was explored and SSMD item design could be optimized. 3. The Cronbach's Alpha coefficient of SSMD is 0.910, which is equivalent to that of GHQ-12 (0.917). The correlation coefficient of Spearman grade between GHQ-12 and SSMD is 0.816. 4. The method of combining clinical method and statistics was established: to find out the crossing point of distribution map between normal people and patients, and to eliminate the potential patients in normal people to find out the most reasonable boundary value of sensitivity specificity by ROC analysis. According to the 5.ROC analysis, the first division was divided into six categories. The sensitivity of SSMD is 94.6, the specificity is 89.1, the false negative rate is 5.4, the false positive rate is 10.9GHQ-12, the sensitivity is 87.7, the specificity is 79.8, the false negative rate is 12.3, the false positive rate is higher than GHQ-12, and the false negative rate is higher than GHQ-12. The false positive rate and false positive rate were lower than GHQ-12.The rate of missed diagnosis was significantly lower than that of GHQ-12. Conclusion:. 1. SSMD obtained the most diagnostic factors with the least number of questions; 2.The reliability of internal consistency of SSMD is equal to that of GHQ-12. The sensitivity and specificity of SSMD are higher than that of GHQ-12, and the false negative rate and false positive rate are both lower than GHQ-12.The overall validity is obviously better than that of GHQ-12.At the same time, the sensitivity and specificity of SSMD is higher than that of GHQ-12. 3. SSMD demarcation is divided into 6 minutes and GHQ-12 is 4 points. 4. A new normal-abnormal demarcation method combining clinical method and measurement is developed. 5. The new technique of item design of screening scale is explored. The expression and factor composition of SSMD items can be further improved. 6. Our mental health outpatient application showed that SSMD's symptom scan range exceeded that of the senior psychiatrist's personal experience, and was superior to the self-expression ability of most clinical patients, and was directly related to the condition and curative effect.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R749

【參考文獻】

相關期刊論文 前9條

1 張理義;涂德華;董波;;中國心身健康量表在國內的應用[J];東南國防醫(yī)藥;2009年02期

2 邊俊士;井西學;莊娜;;癥狀自評量表(SCL-90)在心理健康研究中應用的爭議[J];中國健康心理學雜志;2008年02期

3 章健民;石其昌;付永利;王淑敏;顧衛(wèi);周夏江;胡偉萍;;功能大體評定對12項一般健康問卷假陽性和假陰性的影響分析[J];中國健康心理學雜志;2010年01期

4 肖世富;卜錦炎;嚴和欨;畢華;;一般健康問卷的信度和效度研究[J];上海精神醫(yī)學;1993年03期

5 趙虎,陳曉,陳樹喬,溫碧蘭,陳喜穗,郭沈昌;中國心身健康量表與SCL-90作為篩查工具的應用和適用性比較[J];中國行為醫(yī)學科學;2001年02期

6 王欣,張月娟,翟紅娟,左曉冬;大學生心理健康量表的編制和信效度研究[J];中國臨床心理學雜志;2005年01期

7 張楊;崔利軍;栗克清;江琴普;孫秀麗;高良會;韓彥超;李建峰;劉永橋;嚴保平;呂華;楊保麗;;增補后的一般健康問卷在精神疾病流行病學調查中的應用[J];中國心理衛(wèi)生雜志;2008年03期

8 章健民;石其昌;徐方中;付永利;王淑敏;顧衛(wèi);周夏江;胡偉萍;;12項一般健康問卷假陽性和假陰性率及其相關因素[J];中國心理衛(wèi)生雜志;2010年02期

9 王文強;丁麗君;溫程;廖震華;吳素英;;廈門市18歲及以上人群自殺未遂流行病學調查[J];中國心理衛(wèi)生雜志;2012年05期

相關博士學位論文 前1條

1 許明智;心理健康量表的編制和信效度研究[D];中南大學;2003年

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