患者健康问卷与医院抑郁量表在急性冠脉综合征患者中抑郁筛查的价值

目的:探讨健康抑郁问卷(PHQ-9)和综合医院抑郁量表(HADS-D)在急性冠状动脉综合征(ACS)抑郁障碍患者中的筛查功能,提出筛查界值。方法:2013年1月1日-2014年12月31日在三所综合医院冠心病监护病房连续选取782例ACS患者作为研究对象。患者自主完成PHQ-9、HADS-D,经简明国际神经精神访谈(MINI)中文版访谈,参照DSM-IV重性抑郁发作诊断标准,评估PHQ-9和HADS对重性抑郁发作识别的效度。结果:PHQ-9与HADS-D的内部一致性系数分别为0.84和0.85。符合重性抑郁发作诊断标准122例,针对全部受试者(n=782),PHQ-9和HADS-D的受试者工作曲线(ROC)曲线下面积分别为0.84(SE=0.03,95%CI:0.81～0.89,P<0.05),0.81(SE=0.04,95%CI:0.77～0.85,P<0.05);PHQ-9以10分为筛查界值,敏感度和特异度分别为86.9%与84.7%,阳性预测值和阴性预测值分别为51.3%和97.2%;HADS-D以9分为筛查界值,其敏感度和特异度分别为76.2%与85.5%,阳性预测值和阴性预测值分别为49.2%和95.1%。结论:健康抑郁问卷和综合医院抑郁量表是筛查ACS患者重性抑郁发作的有效工具,健康抑郁问卷的筛查价值可能略优于综合医院抑郁量表。

Application of PHQ-9 and HADS-D in screening major depressive disorder among patients with acute coronary syndrome

Objective: To evaluate the application of Patient Health Questionnaire-9 ( PHQ-9) and Hospital Depression Scale ( HADS-D) in screening major depressive disorder ( MDD) among patients with acute coronary syndrome ( ACS). Methods: A total of 782 patients with ACS from 3 Coronary Care Unit of 3 general hospitals were consecutively selected from January 2013 to December 2014. The patients independently completed the PHQ-9 and HAD-D. MDD diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition,( DSMIV) criteria by interviewing with the Mini International Neuropsychiatric Interview ( MINI). The validity and reliability of PHQ-9 and HAD-D were evaluated. Results: The internal consistency coefficients of PHQ-9 and HADS-D were 0. 84 and 0. 85,respectively. According to the criteria of DSM-IV,122 ACS patients were diagnosed with MDD ( 15. 6%). The area under the ROC curve ( AUC) of PHQ-9 was 0. 84 ( SE =0. 03,95% CI: 0. 81 -0. 89,P <0. 05);with 10 as the cut-off score,its sensitivity,specificity,positive predictive value ( PPV) and negative predictive value ( NPV)were 86. 9%,84. 7%,51. 3% and 97. 2%,respectively. The AUC of HADS-D was 0. 81 ( SE = 0. 04,95%CI: 0. 77 -0. 85,P < 0. 05),with 9 as the cut-off score,its sensitivity,specificity,PPV and NPV were 76. 2%,85. 5%, 49. 2% and 95. 1%,respectively. Conclusion: The Patient Health Questionnaire-9 ( PHQ-9) and Hospital Depression Scale ( HADS-D) are effective screening tools for major depressive disorder in patients with acute coronary syndrome, and PHQ-9 seems to be better than HADS-D.