本文選題：狀態(tài)抑郁 + 特質抑郁　； 參考：《第四軍醫(yī)大學》2016年碩士論文

【摘要】：隨著時代快速發(fā)展,物質生活水平不斷提高,人類的精神世界卻隨著外界的高速運行凸顯出了一系列適應性問題。世界衛(wèi)生組織(WHO)等其它衛(wèi)生機構都根據(jù)近十幾年的醫(yī)療現(xiàn)狀預測,在可見的未來,抑郁癥很可能會成為導致人類社會死亡和殘疾的重要致病因素,成為最重要的衛(wèi)生問題。盡管抑郁癥的診斷和治療顯得十分急迫,但相關調查發(fā)現(xiàn),由于抑郁癥患者多數(shù)情況下選擇的是綜合醫(yī)院,加之內科門診醫(yī)生對心理障礙的識別率不高(調查發(fā)現(xiàn)僅為21%),導致接受抗抑郁治療的患者也為數(shù)不多(僅為5%)。因此,提升初級醫(yī)療機構中非精神科醫(yī)務人員關于心理問題的識別能力就顯得十分必要。本研究從抑郁癥的癥狀出發(fā),通過總結整理美國精神疾病診斷標準(第3版)、國際疾病分類(第10版)和中國精神障礙分類及診斷標準(第3版)中關于抑郁癥的診斷描述,歸納總結了9大類抑郁癥的常見癥狀,并按照狀態(tài)-特質進行劃分,搜集通用的抑郁測評量表,組建題庫。本研究的主要研究結果有:1.根據(jù)抑郁癥狀的不同類別,將9大類癥狀區(qū)分為狀態(tài)-特質抑郁,其中,狀態(tài)抑郁包括:精神運動性問題、生理狀況(軀體感受,睡眠情況,飲食情況)、抑郁心境、注意力減退;特質抑郁包括:負性態(tài)度、無力自責感、社會關系、死亡觀念、興趣缺失。2.對題庫中所有條目進行項目反應理論的參數(shù)估計,各個癥狀維度的測驗信息量都達到了理想位置,保留的97道條目的區(qū)分度均0.7,探索性因素分析(EFA)的結果都體現(xiàn)了良好的因子結構,驗證性因素分析(CFA)的結果所有條目的載荷均在0.4以上,CFI和TLI均在0.95以上,RMSEA的估計值小于0.05,90%的置信區(qū)間在精確擬合的范圍內,WRMR的估計值也在可接受的范圍內。狀態(tài)抑郁各維度Cronbach’sα系數(shù)平均值為0.768,特質抑郁各維度Cronbach’sα系數(shù)平均值為0.790,狀態(tài)抑郁和特質抑郁分量表的α系數(shù)分別為0.949和0.956。3.結構方程模型(SEM)分析結果顯示,最終有5個狀態(tài)-特質抑郁癥狀維度相關模型,模型1:狀態(tài)抑郁的抑郁心境(S3)和注意力減退(S4)癥狀維度對特質抑郁的負性態(tài)度(T1)癥狀維度的路徑系數(shù)分別為0.804和0.175;模型2:狀態(tài)抑郁的抑郁心境(S3)和注意力減退(S4)癥狀維度對特質抑郁的無力感(T2)癥狀維度的路徑系數(shù)分別為0.71和0.27;模型3:狀態(tài)抑郁的睡眠情況(S2.2)和抑郁心境(S3)癥狀維度對特質抑郁的社會關系(T3)癥狀維度的路徑系數(shù)分別為0.187和0.725;模型4:狀態(tài)抑郁的抑郁心境(S3)癥狀維度對特質抑郁的死亡觀念(T4)癥狀維度的路徑系數(shù)為0.87;模型5:狀態(tài)抑郁的抑郁心境(S3)癥狀維度對特質抑郁的興趣缺失(T5)癥狀維度的路徑系數(shù)為0.95。研究結論:1.狀態(tài)-特質抑郁題庫有較好的信度和效度,具有良好的心理測量學特性,提示可應用于抑郁檢測;2.狀態(tài)-特質抑郁各癥狀維度的結構方程模型提示了各自癥狀的組合模式,預期可對臨床診斷提供參考。
[Abstract]:With the rapid development of the times and the continuous improvement of material life, the spiritual world of human beings has highlighted a series of adaptability problems with the rapid operation of the outside world. The World Health Organization (WHO) and other health institutions have predicted that depression is likely to become an important cause of death and disability in human society and the most important health problem in the foreseeable future. Despite the urgency of diagnosis and treatment of depression, the survey found that patients with depression in most cases chose a general hospital. In addition, the rate of recognition of mental disorders by physicians was not high (the survey found that only 21 patients were diagnosed with antidepressants, and the number of patients receiving antidepressant treatment was only 5%. Therefore, it is necessary to improve the ability of non-psychiatric medical personnel to identify mental problems in primary medical institutions. Based on the symptoms of depression, this study summarized the diagnostic descriptions of depression in the US (3rd edition), the International Classification of Diseases (10th Edition) and the Chinese Classification and Diagnostic criteria of Mental Disorder (3rd Edition). The common symptoms of 9 kinds of depression were summarized and classified according to state-trait. The general depression evaluation scale was collected and the question bank was set up. The main results of this study are: 1: 1. According to the different types of depressive symptoms, 9 major symptoms are classified as state-trait depression, in which state depression includes: psychomotor problems, physiological conditions (somatosensory, sleep, diet, depression, depression), Attention loss; trait depression includes: negative attitudes, inability to blame, social relationships, death concepts, and lack of interest. 2. By estimating the parameters of the item response theory for all the items in the item bank, the test information of each symptom dimension has reached the ideal position. The differences of 97 items were 0.7.The results of exploratory factor analysis (EFAA) showed a good factor structure. The results of the confirmatory factor analysis (CFAA) show that the loads of all entries are above 0.4 and the estimated values of RMSEA and TLI are above 0.95. The confidence intervals of less than 0.0590% of the estimated values are within the range of accurate fitting and the estimated values of WRMR are also within the acceptable range. The average value of Cronbachs 偽 coefficient in each dimension of state depression was 0.768, and the average coefficient of Cronbachs 偽 coefficient in every dimension of trait depression was 0.790. The 偽 coefficients of state depression and trait depression component tables were 0.949 and 0.956.3 respectively. The results of structural equation model (SEM) showed that there were 5 status-trait depression dimension correlation models. Model 1: the path coefficients of symptom dimension of depression (S3) and attention deficit (S4) were 0.804 and 0.175, respectively; Model 2: depressive mood of state depression (S3) and attentional depression (S4) The path coefficients of symptom dimension to trait depression were 0.71 and 0.27, respectively; Model 3: sleep status of state depression and depression state of mind were 0.71 and 0.27, respectively. Model 3: the path of symptom dimension to social relationship of trait depression and symptom dimension of depression were 0.71 and 0.27, respectively; Model 3: sleep status of state depression and depression state of mind S3) the pathway of symptom dimension to social relationship of trait depression. Model 4: the path coefficient of symptom dimension of depressive state to death of trait depression and T4) symptom dimension was 0.87; model 5: symptom dimension of depressive state of depressive mood and S3) symptom dimension to trait depression was 0.87; Model 5: depression of state of depressive state of mind (S3) symptom dimension to idiosyncratic depression. The path coefficient of the symptom dimension was 0.95. Conclusion: 1. The state-trait depression question bank has good reliability and validity, and has good psychometric characteristics, suggesting that it can be used in depression test. The structural equation model of the dimensions of state-trait depression indicates the combination pattern of their symptoms, which is expected to provide reference for clinical diagnosis.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R749.4
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本文編號：2006079