目的:考查世界卫生组织五项身心健康指标(World Health Organization Five-item Well-Being Index,WHO-5)在识别高中生抑郁障碍中的信度和效度.方法:用WHO一对上海市1所中学706名高一到高三年级学生进行初测,计算WHO一的Cronbach a系数,进行因子分析判定其结构效度;初测同时使用Beck抑郁量表(Beck Depression Inventory,BDI )测试,计算WHO-5与BDI平行效度;2周后对104名学生用WHO-5进行重测,计算重测信度;对BDI总分≥14分的学生和10%的BDI总分<14分的学生共134人用简明国际神经精神访谈(Mini International Neuropsychiatry Inventory,NUM)进行访谈,根据WHO-5总分以MM诊断抑郁障碍为金标准绘制ROC曲线,判定其校标效度,确定曲线下面积、临界值及相对应的敏感度和特异度.结果:Cronbach a系数为0.907;重测信度系数ICC = 0.644;因子分析表明WHO-5为单因子结构;WHO-5与BDI得分呈负相关(r=-0.52); ROC曲线下面积为0.714,临界值取11.5或12.5时有较平衡的敏感度/特异度,分别为70%/62%或85%/56%.结论:世界卫生组织五项身心健康指标具有较好的内在一致性,但敏感度尚可而特异度一般.其对高中生抑郁障碍的识别有一定适用性,但只能作为一种粗筛工具.%Objective: To examine the reliability and validity of the World Health Organization Five-item Well-Being Index ( WHO-5) for detecting depressive disorders in senior middle school students. Methods: A sample of 706 grade I to grade 3 students from one senior middle school in Shanghai completed the WHO-5. Cronbach' s alpha coeffiicient and structure validity were examined. Structure validity was evaluated using factor analysis. The Beck Depression Inventory ( BDI) was used to explore the correlative validity. Totally 104 students were readministered the WHO-5 2 weeks after its initial administration to assess the test-retest reliability. And 134 students were also interviewed by psychiatrists to assess whether they had any depressive disorders according to Mini International Neuropsychiatry Inventory ( MINI) . MINI was regarded as the gold standard to investigate the validity of WHO-5. Criterion-related validity was evaluated using receiver operating characteristic ROC analysis. Results: The Cronbach's alpha was estimated to be 0. 907. the test-retest reliability was 0. 644. A factor analysis identified only one factor. The WHO-5 was significantly correlated with BDI. Correlative validity was - 0. 52. ROC analysis showed that the WHO-5 could be used to detect depressive disorders ( area under curve: 0. 714). A cut-off of 11. 5 or 12. 5 yielded the balanced sensitivity/specificity trade-off: 70％ /62％ or 85 ％ /56％ . Conclusion: The World Health Organization Five-item Well-Being Index (WHO-5) has an adequate internal consistency. The WHO-5 demonstrates good sensitivity and common specificity. It may be a coarse-screen instrument for detecting depressive disorders in senior middle school students.
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