| 赵高锋,张强,庞艳,任正伽,彭丹,江国帼,刘善明,陈颖,耿婷,张树森,杨彦春,邓红.中文版儿童事件影响量表在汶川地震极重灾区中小学生中的应用及分析[J].Chinese journal of Epidemiology,2009,30(11):1160-1164 |
| 中文版儿童事件影响量表在汶川地震极重灾区中小学生中的应用及分析 |
| Application of the Children's Impact of Event Scale(Chinese Version)on a rapid assessment of posttraumatic stress disorder among children from the Wenchuan earthquake area |
| Received:May 19, 2009 |
| DOI： |
| KeyWord: 儿童事件影响量表 信度 效度 创伤后应激障碍 |
| English Key Word: The Children'S Impact of Event Scale(cIuEs-13) Sensitivity Specificity Posttraumatic stress disorder |
| FundProject: |
| Author Name | Affiliation | E-mail | | ZHAO Gao-feng | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | ZHANG Qiang | 华西公共卫生学院卫生统计学教研室 | | | PANG Yan | 华西公共卫生学院卫生统计学教研室 | | | REN Zheng-jia | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | PENG Dan | 华西公共卫生学院卫生统计学教研室 | | | JIANG Guo-guo | 华西公共卫生学院卫生统计学教研室 | | | LIU Shan-ming | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | CHEN Ying | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | GENG Ting | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | ZHANG Shu-sen | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | YANG Yan-chun | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | | | DENG Hong | Mental Health Center, West China Hospital, Sichuan University, Chengdu 61004l, China | rhdeng88@hotmail.com |
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| Abstract: |
| 目的评价中文版(简体)儿童事件影响量表(CRIES-13)的信度和效度,探讨利用该量表筛检创伤后应激障碍(PTSD)的价值及最佳评分切割点.方法采用分层随机整群抽样原则,选取253名汶川地震后幸存儿童作为被评估对象,采用量表白评和临床诊断相结合的方法,分析量表的内部-致性、条目间平均相关系数|总分与各因子间的相关系数、内容区分效度.临床诊断依据DSM.IV诊断标准中PTSD诊断标准确诊患者.采用受试者工作特征曲线计算曲线下面积和不同切割点下筛检PTSD的灵敏度、特异度及约登指数,以约臀指数最大的点为最佳切割点.结果CRIES.13的Cronbach'S Q系数为0.903,条目间平均相关系数0.283-0.689.总分与各冈子的相关系数0.836-0.868,各因子间的相关系数0.568～O.718|在总分、闯入、回避和高警觉因子评分方面,PTSD组均高于非PTSD组,差异有统计学意义(P P>O.05),CRIES.13以18分为切割点时筛检PTSD的约登指数最大,为57.6%,PTSD患者诊断预测的灵敏度为81.1%,特异度为76.5%,诊断效率81.1%.而选取32分切割点,筛查结果与临床诊断-致性较高(Kappa值=O.529).结论CRIES.13在汶川地震后幸存儿童中具有良好的信、效度,可作为该群体-个较好的创伤后应激症状测评工具.CRIES.13评分18分切割点可作为汶川地震后极重灾区中小学生筛检PTSD患者和确诊高危人群的切割点,而32分切割点筛检阳性率可初步预测灾后极重灾区中小学生PTSD患病率,此结论还有待于进-步研究证实. |
| English Abstract: |
| Objective To explore the reliability and validity of the Children's Impact of Event Scale(Chinese version.CRIES-13)and to determine the value and the optimal cutoff point of the score of CRJES-13 in screening posttraumatic stress disorder(PTSD), so as to provide evidence for PTSD prevention and identify children at risk in Wenchuan earthquake areas.Methods A total of 253 children experienced the Wenchuan earthquake were tested through Stratified random cluster sampling.The authors examined CRJES-13's intemal consistency.discriminative validity and predictive value of the cut-off.PTSD was assessed wim the DSM-IV criteria.Area under the carve while sensitivity, specificity and Youden index were computed based on the receiver operating characteristic curve analysis.Optimal cutoff Doint was determined by the maximum of Youden index.Resuits 20.9%of the subiects were found to have met the DSM-IV criteria for PTSD 7 mortths after the Wenchuan earthquake accident. The Cronbach'S coefficient ofCRIES.13 was 0.903 and the mean inter-item correlation coefficients ranged from 0.283 to 0.689, the correlation coefficient of the threefactors with me total scale scores ranged from 0.836 to 0.868 while the correlation coefficient among the three factors ranged from 0.568 to 0.7l8, PTSD cases indicated much higher scores than non-PTSD cases.the Youden index reached maximum value when the total score approached 18 in CRJES-13 with sensitivity and specificity as 81.1%and 76.5% respectively. Consistency check showed that there were no significant differences between the Results of CRIES-13 score≥32 and clinical diagnosis (Kappa=0.529)from the screening program. Conclusion CRJES-13 appeared to be a reliable and valid measure for assessing the posttraumatic stress symptoms among childrell after the earthquake accident in the Wenchuan area.The CKIES-13 seemed to be a useful self-rating diagnostic instrument for survivors with PTSD symptoms as a clinical concern by using a 18 cut-off in total score.Consistency check showed that there was no significant difference between the screening result of CRIES-13 score≥32 and elinical diagnosis. |
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