目的：评价病人健康问卷抑郁自评量表（ PHQ-9）在住院糖尿病足溃疡患者中应用的信效度。方法选取2014年8月—2015年6月在广州市某三甲医院内分泌科住院治疗的糖尿病足溃疡患者120例。采用自行设计的一般资料调查表收集患者的一般资料；采用PHQ-9评价患者的抑郁情况，并对量表进行信效度检验，包括内容效度、结构效度、已知族群效度、内部一致性及重测信度；采用美国《精神障碍诊断与统计手册（4版）》（DSM-IV）临床定式访谈（ SCID）抑郁量表对PHQ-9的评价结果进行验证，并确定重性抑郁的诊断临界值。结果 PHQ-9共包括9个条目，各条目内容效度指数（ I-CVI）分别为1.00、1.00、1.00、0.83、1.00、1.00、0.83、1.00、1.00，总量表内容效度指数（S-CVI）为0.96。PHQ-9的平均总得分为（11.7±6.4）分，Pearson相关分析结果显示，各条目得分与量表总得分间均呈线性正相关（ P﹤0.05）。因子分析共获得2个公因子，分别为认知-情感因子、躯体症状因子，可共同解释量表62.1%的变异量。不同性别、家庭人均月收入、自理能力、Wagner 分级、足溃疡疼痛评分（ NRS）以及有无截肢/趾史或风险患者的认知-情感维度得分比较，差异有统计学意义（ P﹤0.05）；不同自理能力、足溃疡NRS以及有无截肢/趾史或风险患者的躯体症状维度得分比较，差异有统计学意义（ P﹤0.05）。总量表、认知-情感维度、躯体症状维度的Cronbach＇sα系数分别为0.88、0.86、0.70，重测信度分别为0.87、0.89、0.83。受试者工作特征（ ROC）曲线显示，PHQ-9用于筛查住院糖尿病足溃疡患者抑郁情况有统计学意义〔曲线下面积（ AUC）＝0.914，95%CI（0.862，0.967），P﹤0.05〕，10分为重性抑郁的诊断临界值，灵敏度为0.928、特异度为0.804。结论 PHQ-9在住院糖尿病足溃疡患者中应用的信效度较好，10分为重性抑郁的诊断临界值，灵敏度和特异度均较高，建议应用于住院糖尿病足溃疡患者的抑郁筛查。%Objective To evaluate the reliability and validity of patient health questionnaire -9 ( PHQ -9 ) in inpatients with diabetic foot ulcers(DFU). Methods 120 inpatients with DFU,who had received treatment in endocrinology department of one top three hospitals in Guangzhou from August 2014 to June 2015,were recruited in this study. We adopted self-designed general information questionnaire to collect the general data of patients;evaluated the depression situation of patients by PHQ-9 and tested the reliability and validity of the questionnaire,including content validity,construct validity,known-group validity,internal consistency reliability and test-retest reliability;verified the evaluated results of PHQ-9 by depression scale of Structured Clinical Interview(SCID)for American Diagnostic and Statistical Manual of Mental Disorders(4th Version) ( DSM-IV),and determined the diagnostic critical value of major depression. Results PHQ-9 included 9 items totally,the content validity index(I-CVI)of each item was 1. 00,1. 00,1. 00,0. 83,1. 00,1. 00,0. 83,1. 00,1. 00 respectively, and the content validity index of total scale(S-CVI)was 0. 96. The average total score of PHQ-9 was(11. 7 ± 6. 4),the result of Pearson correlation analysis showed that there was a linear positive correlation between scores of each item and of the total scale(P﹤0. 05). We got two common factors,they were cognitive-emotion factor and somatic symptom factor,which could interpret 62. 1% amount of variability of the scale jointly. Significant difference was found in cognitive-emotion dimension scores among patients with different genders,monthly incomes per person,self-care abilities,Wagner ranks,numerical rating scale scores(NRS)of DFU,and history or risk of limb/toe amputation(P﹤0. 05);and significant difference was found in somatic symptoms dimension scores among patients with different self-care abilities,NRS of DFU,history or risk of limb/toe amputation (P﹤0. 05). The Cronbach's α coefficient of total scale,cognitive -emotion dimension and somatic symptom dimension was 0. 88,0. 86 and 0. 70 respectively;the test-retest reliability coefficient was 0. 87,0. 89 and 0. 83 respectively. The receiver operating characteristics( ROC)showed that there was significant difference in screening depression situation of DFU patients by PHQ-9〔area under the curve(AUC) =0. 914,95%CI(0. 862,0. 967),P ﹤0. 05)〕,the diagnostic critical value of major depression was 10,sensitivity was 0. 928 and specificity was 0. 804. Conclusion The PHQ-9 application in DFU patients shows good reliability and validity. The diagnostic critical value of major depression was 10 with rather high sensitivity and specificity. The application of PHQ-9 in screening depression disorders for DFU inpatients was suggested.
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