《患病行为问卷》的信度、效度初步测试

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目的:引进并测定《患病行为问卷》(Illiness Behavior Questionnaire)的信度和效度。方法:将《患病行为问卷》译成中文,并回译。以心内科住院病人(25例)为样本,间隔2周评定复测信度。以胸闷胸痛为确诊冠心病而住院的患者(46例)为样本,评定效标效度。对效度测评组患者进行了精神科临床诊断(ICD-10标准),同时采用的工具有:《一般健康问卷-28》( General Health Questionnaire - 28)《医院内焦虑抑郁量表》(Hospital Anxiety and Depression)以及汉密尔顿焦虑、抑郁量表。另外,在精神科门诊连续收集躯体症状类似的焦虑性精神障碍及神经衰弱(ICD-10标准)的初诊患者18例作为精神科对照组。结果:中译本回译一致率95%,复测信度82.5%。原量表共11个因子,主要分为两个维度,分别反映不良情绪和病感。以我国心内科的住院患者为样本,反映情绪的4个因子与《一般健康问卷》、《医院内焦虑抑郁量表》结果相关(r=0.5-0.6,P<0.01),与精神科医生用汉密尔顿焦虑、抑郁量表评定的结果相关(r=0.5-0.6,p<0.01)。综合考虑《患病行为问卷》的病感因子和情绪因子,不同心理健康水平的心内科患者间有所区别,《患病行为问卷》各因子综合考虑,能够反映出内科就诊患者中心理健康状况较差者与相对健康的患者间的不同,即前者不良情绪明显,且病感强;同时也能反映出内科心理健康状况不佳者与在精神科就诊的神经症患者之间的差异:即两者在病感上类似,而到精神科就诊者不良情绪更明显。量表中译本反映的情况与临床观察一致,体现了原量表设计者的理论构想。在中国综合医院筛查的临界值与英文原本的临界值接近。结论:《患病行为问卷》中译本经初步测试信度、效度满意,建议可以扩大样本试用,进行因子分析,并在此基础上进一步修订。“,”Objective: To introduce Illness Behavior Questionnaire (IBQ) into China, and test the reliability and validity of its Chinese Version. Method: The text of IBQ came from its author, Prof. Issy Pilowsky and was translated into Chinese by Shengli. The back translation was done by a Canadian psychotherapist not familiar with it. The test- retest reliability was done at an interval of 2 weeks in 25 inpatients in a cardiac ward. Based on a sample of 46 inpatients with chest pain in a cardiac ward, the criteria validity was tested. All 46 patients were interviewed by one psychiatrist. Psychiatric diagnosis was made if necessary (according to ICD - 10) . Other instruments included: General Health Questionnaire (GHQ),Hospital Anxiety and Depression Scale (HAD) . Another group sampled in psychiatric out- clinic (18 patients with anxiety disorder or neurasthnia) was used as neurotic control. Results: Judged by meaning, the consistency between back- translation and the original text was 95%. The test- retest reliability was 82.5%. From all 11 indices of IBQ, there were positive correlation between scores of indices reflecting mood ( GH, AD, I and AS) and the scores of GHQ or HAD (r = 0.5 ~ 0.6,p<0.01) . Positive correlation also existed between them and the scores assessed by HAMA and HAMD (r=0.5~0.6, p<0.01) . The difference of illness behavior between inpatients with chest pain with mental disorders or in sub- clinical states and those without could be reflected by IBQ, i.e. those with mental health problems had higher scores in disease conviction (DC) and Whiteley Index (WI), as well as had higher scores in negative affection staes (AS) . Compared with neurotic group, patients without mental health problem had lower score in DC, WI and AS, while tbose with such problems had similar results in DC and WI with the neurotic control, but lower AS score. The cut- off points for screening mental health problem using DC and WI were 2 ~ 3 and 6 ~ 7 respectively, similar to the cut - off points of the English version (2 ~ 3 and 7 ~ 8 respectively) . Conclusion: The reliability and validity of IBQ - Chinese Version is satisfying. It is worth of doing more work in factor analysis.
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