新型冠状病毒肺炎心理应激调查问卷的信效度检验

doi:10.3969/j.issn.1674-8115.2021.10.014

摘要/Abstract

摘要：

目的·探索新型冠状病毒肺炎心理应激调查问卷用于测评疫情相关急性应激反应的信度及效度。方法·2020年1月31日—2020年2月29日，向253名于上海交通大学医学院附属精神卫生中心门诊就诊患者、家属及医务人员施测新型冠状病毒肺炎心理应激调查问卷（COVID-19 Peritraumatic Distress Index，CPDI）及患者健康问卷抑郁量表（Patient Health Questionnaire-9，PHQ-9）、广泛性焦虑量表（General Anxiety Disorder-7，GAD-7）、心理健康自评问卷（Self-reporting Questionnaire-20，SRQ-20），同时通过舒辅智慧心理测试平台在线对全国75 867名被试施测CPDI。采用克龙巴赫α系数（Cronbach's α coefficient，Cronbach's α）评估量表的信度。同时对CPDI与PHQ-9、GAD-7及SRQ-20的相关性进行效标效度检验，用探索性因素分析检测结构效度，并检测其筛查新型冠状病毒肺炎疫情心理应激症状的分界值。结果·15项CPDI问卷信度分析结果显示Cronbach's α 为 0.932。该问卷与PHQ-9、GAD-7、SRQ-20的相关系数分别为0.670、0.699、0.711（均P=0.000）。探索性因子分析结果包含4个因子，因子负荷为0.491~0.681，累积方差解释率为72.006%。判别为可疑存在症状，分界值为10分，灵敏度和特异度分别为0.822、0.811；判别为确定存在症状，分界值为14分，灵敏度和特异度分别为0.815、0.824。结论·新型冠状病毒肺炎心理应激调查问卷的内部一致性信度、效标效度及结构效度良好。

关键词: 新型冠状病毒肺炎, 心理应激, 问卷, 信度, 效度

Abstract:

Objective·To explore the reliability and validity of Corona Virus Disease 2019 (COVID-19) Peritraumatic Distress Index (CPDI) in evaluating pandemic-related acute stress reaction.

Methods·From 31 January 2020 to 29 February 2020, CPDI, Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Self-reporting Questionnaire-20 (SRQ-20) were measured in 253 outpatients, their family members and medical staff of our hospital. At the same time, leveraging the Siuvo Intelligent Psychological Assessment Platform, we presented QR codes of the CPDI questionnaire online openly, accessible to the participants nationwide, and received a total of 75 867 valid responses. Cronbach's α coefficient was used to evaluate the internal consistency. The correlation between CPDI and PHQ-9, GAD-7 and SRQ-20 was used to test the criterion validity. Exploratory factor analysis was used to detect the structural validity and the cut-off score of the questionnaire to screen the psychological symptoms associated with COVID-19 was also detected.

Results·The Cronbach's α of the 15-item questionnaire was 0.932. The correlation coefficients between the 15-item CPDI and PHQ-9, GAD-7 and SRQ-20 were 0. 670, 0.699 and 0.711 respectively (all P=0.000). The exploratory factor analysis results contained 15 items and 4 factors, the factor load was 0.491-0.681, and the cumulative variance interpretation rate was 72.006%. In terms of cut-off score, it was identified as suspicious symptom by cut-off score of 10/11 points. The sensitivity and specificity were 0.822 and 0.811, respectively. The cut-off score to confirm the presence of symptoms was 14/15 points. The sensitivity and specificity were 0.815 and 0.824, respectively.

Conclusion·The study indicates that CPDI is with good internal consistency reliability, criterion validity and structural validity.

Key words: COVID-19, peritraumatic distress, questionnaire, reliability, validity

中图分类号:

R749.92

陶晶, 曾庆枝, 党金, 仇剑崟. 新型冠状病毒肺炎心理应激调查问卷的信效度检验[J]. 上海交通大学学报(医学版), 2021, 41(10): 1359-1365.

Jing TAO, Qing-zhi ZENG, Jin DANG, Jian-yin QIU. Reliability and Validity of Corona Virus Disease 2019 (COVID-19) Peritraumatic Distress Index (CPDI)[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(10): 1359-1365.

图/表 9

参考文献 8

1	Beusenberg M, Orley JH, Division of Mental Health, World Health Organization. A user's guide to the self reporting questionnaire (SRQ)[M]. Geneva: World Health Organization, 1994.
2	American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision[M]. Washington, DC: American Psychiatric Association, 2000.
3	徐勇,吴海苏,徐一峰. 病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用: 信度与效度分析[J]. 上海精神医学,2007,19(5):257-259, 276.
4	胡星辰,张迎黎,梁炜,等. 病人健康问卷抑郁量表(PHQ-9)在青少年中应用的信效度检验[J]. 四川精神卫生,2014,27(4):357-360.
5	何筱衍,李春波,钱洁,等. 广泛性焦虑量表在综合性医院的信度和效度研究[J]. 上海精神医学,2010,22(4):200-203.
6	Emmelkamp PM. Specific and social phobias in ICD-11[J]. World Psychiatry, 2012, 11: 94-99.
7	Maercker A. EPA-0111-ICD-11: stress-related disorders[J]. European Psychiatry, 2014, 29:1.
8	邹莉玲, 余小金, 闵捷, 等. ROC曲线在医学诊断中的应用与进展[J]. 东南大学学报(医学版), 2003, 22(001):67-70.

项目 Item	很少 Occasionally	有时 Sometimes	大部分时间 Often	绝大部分时间 Most of the time
1. 我比平时更容易感到紧张和着急 Compared to usual， I feel more nervous and anxious	1	2	3	4
2. 我心里烦乱，感到莫名的不安，到处采购超量的口罩、中草药、消毒水及生活物资等 I feel insecure and bought a lot of masks， medications， sanitizer， gloves and/or other home supplies	1	2	3	4
3. 我会不由自主地想象家人或自己被感染的场景，对此感到烦躁及恐惧 I cannot help imaging the scenario that my family or myself is infected， thus feeling restless and scared	1	2	3	4
4. 我感到无助且空虚，感觉做什么都无济于事 I feel empty and helpless no matter what I do	1	2	3	4
5. 我对新型冠状病毒感染患者及其家属的经历感同身受，感到悲伤、难过 I feel sympathetic to the COVID-19 patients and their families. I feel sad about them	1	2	3	4
6. 我心力交瘁，感觉生气。例如对周围人、政府官员、媒体等感到愤怒 I feel helpless and angry about people around me， governors， and media	1	2	3	4
7. 我逐渐失去对周围环境或人的信任感 I am losing faith in the people around me	1	2	3	4
8. 我整日反复搜索或关注疫情信息，即使这可能是不必要的，但我依然难以控制自己的行为 I collect information about COVID-19 all day. Even if it’s not necessary， I can’t stop myself	1	2	3	4
9. 我会不加判断地相信各种渠道来源的疫情信息 I will believe the COVID-19 information from all sources without any evaluation	1	2	3	4
10. 我似乎更倾向于相信一些疫情相关的负面消息，而对正面消息持怀疑态度 I would rather believe in some negative information about the epidemic than the positive news	1	2	3	4
11. 我会不断分享疫情相关信息（多数为负面） I am constantly sharing news about COVID-19 （mostly negative news）	1	2	3	4
12. 我会因恐惧而主动回避有关疾病的信息 I avoid watching COVID-19 news， since I am too scared to do so	1	2	3	4
13. 我脾气暴躁，因一点小事与家人发生冲突 I am more irritable and have frequent conflicts with my family	1	2	3	4
14. 我感到劳累，甚至有些时候感到精疲力竭 I feel tired and sometimes even exhausted	1	2	3	4
15. 因长时间的烦躁，我感觉有些反应迟缓 Due to feelings of anxiety， my reactions are becoming sluggish	1	2	3	4
16. 我感到难以集中注意力 I find it hard to concentrate	1	2	3	4
17. 我难以对事情做出决策 I find it hard to make any decisions	1	2	3	4
18. 在疫情流行期间，我容易感到头晕、背部疼痛、胸闷 During this COVID-19 period， I often feel dizzy or have back pain and chest distress	1	2	3	4
19. 在疫情流行期间，我容易感到胃痛、胃胀等肠胃不适 During this COVID-19 period， I often feel stomach pain， bloating， and other stomach discomfort	1	2	3	4
20. 我与他人交流时有不顺畅的感觉 I feel uncomfortable when communicating with others	1	2	3	4
21. 我最近很少和家人讲话 Recently， I rarely talk to my family	1	2	3	4
22. 睡眠不好，梦到自己或家人被感染新型冠状病毒 I cannot sleep well. I always dream about myself， or my family being infected by COVID-19	1	2	3	4
23. 食欲不振 I lost my appetite	1	2	3	4
24. 便秘、小便频繁 I have constipation or frequent urination	1	2	3	4

项目 Item	很少 Occasionally	有时 Sometimes	大部分时间 Often	绝大部分时间 Most of the time
1. 我比平时更容易感到紧张和着急 Compared to usual， I feel more nervous and anxious	1	2	3	4
2. 我心里烦乱，感到莫名的不安，到处采购超量的口罩、中草药、消毒水及生活物资等 I feel insecure and bought a lot of masks， medications， sanitizer， gloves and/or other home supplies	1	2	3	4
3. 我会不由自主地想象家人或自己被感染的场景，对此感到烦躁及恐惧 I cannot help imaging the scenario that my family or myself is infected， thus feeling restless and scared	1	2	3	4
4. 我感到无助且空虚，感觉做什么都无济于事 I feel empty and helpless no matter what I do	1	2	3	4
5. 我对新型冠状病毒感染患者及其家属的经历感同身受，感到悲伤、难过 I feel sympathetic to the COVID-19 patients and their families. I feel sad about them	1	2	3	4
6. 我心力交瘁，感觉生气。例如对周围人、政府官员、媒体等感到愤怒 I feel helpless and angry about people around me， governors， and media	1	2	3	4
7. 我逐渐失去对周围环境或人的信任感 I am losing faith in the people around me	1	2	3	4
8. 我整日反复搜索或关注疫情信息，即使这可能是不必要的，但我依然难以控制自己的行为 I collect information about COVID-19 all day. Even if it’s not necessary， I can’t stop myself	1	2	3	4
9. 我会不加判断地相信各种渠道来源的疫情信息 I will believe the COVID-19 information from all sources without any evaluation	1	2	3	4
10. 我似乎更倾向于相信一些疫情相关的负面消息，而对正面消息持怀疑态度 I would rather believe in some negative information about the epidemic than the positive news	1	2	3	4
11. 我会不断分享疫情相关信息（多数为负面） I am constantly sharing news about COVID-19 （mostly negative news）	1	2	3	4
12. 我会因恐惧而主动回避有关疾病的信息 I avoid watching COVID-19 news， since I am too scared to do so	1	2	3	4
13. 我脾气暴躁，因一点小事与家人发生冲突 I am more irritable and have frequent conflicts with my family	1	2	3	4
14. 我感到劳累，甚至有些时候感到精疲力竭 I feel tired and sometimes even exhausted	1	2	3	4
15. 因长时间的烦躁，我感觉有些反应迟缓 Due to feelings of anxiety， my reactions are becoming sluggish	1	2	3	4
16. 我感到难以集中注意力 I find it hard to concentrate	1	2	3	4
17. 我难以对事情做出决策 I find it hard to make any decisions	1	2	3	4
18. 在疫情流行期间，我容易感到头晕、背部疼痛、胸闷 During this COVID-19 period， I often feel dizzy or have back pain and chest distress	1	2	3	4
19. 在疫情流行期间，我容易感到胃痛、胃胀等肠胃不适 During this COVID-19 period， I often feel stomach pain， bloating， and other stomach discomfort	1	2	3	4
20. 我与他人交流时有不顺畅的感觉 I feel uncomfortable when communicating with others	1	2	3	4
21. 我最近很少和家人讲话 Recently， I rarely talk to my family	1	2	3	4
22. 睡眠不好，梦到自己或家人被感染新型冠状病毒 I cannot sleep well. I always dream about myself， or my family being infected by COVID-19	1	2	3	4
23. 食欲不振 I lost my appetite	1	2	3	4
24. 便秘、小便频繁 I have constipation or frequent urination	1	2	3	4

Scale	Score	Severity/score	Count/n	Percentage/%
PHQ-9	3.85±4.99	Normal （<5）	166	66.9
		Mild （5-9）	51	20.6
		Moderate and above（≥10）	31	12.5
GAD-7	5.36±6.48	Normal （<5）	148	59.7
		Mild （5-9）	53	17.3
		Moderate and above （≥10）	57	23.0
SRQ-20	5.00±5.56	No psychological distress （≤7）	172	69.4
		With psychological distress （>8）	76	30.6
CPDI-24 （offline）	14.93±14.06	‒	‒	‒
CPDI-24 （online）	18.00±15.80	‒	‒	‒

Scale	Score	Severity/score	Count/n	Percentage/%
PHQ-9	3.85±4.99	Normal （<5）	166	66.9
		Mild （5-9）	51	20.6
		Moderate and above（≥10）	31	12.5
GAD-7	5.36±6.48	Normal （<5）	148	59.7
		Mild （5-9）	53	17.3
		Moderate and above （≥10）	57	23.0
SRQ-20	5.00±5.56	No psychological distress （≤7）	172	69.4
		With psychological distress （>8）	76	30.6
CPDI-24 （offline）	14.93±14.06	‒	‒	‒
CPDI-24 （online）	18.00±15.80	‒	‒	‒

Item	x^①	s^2②	Correlation^③	SMC	Cronbach's α
S1	9.38	86.068	0.635	0.484	0.929
S2	9.83	88.100	0.614	0.467	0.929
S3	9.84	87.202	0.655	0.501	0.928
S9	9.89	88.443	0.584	0.404	0.930
S10	9.88	87.124	0.646	0.494	0.928
S11	9.89	88.602	0.580	0.427	0.930
S13	9.88	87.224	0.668	0.497	0.928
S14	9.77	84.895	0.752	0.664	0.925
S15	9.90	85.278	0.784	0.722	0.924
S16	9.77	84.763	0.753	0.701	0.925
S17	9.85	86.113	0.738	0.646	0.926
S19	10.08	87.990	0.689	0.520	0.927
S22	10.30	90.572	0.644	0.483	0.929
S23	10.21	89.710	0.656	0.552	0.928
S24	10.18	89.596	0.640	0.513	0.928