中文版布罗塞特暴力风险评估量表的效度和信度检验

Classified Index: CODE: 10075 U.D.C: NO: 20121812A Dissertation for the Degree of M. Medicine Validity and reliability of the Chinese Version of the Brøset Violence ChecklistCandidate: Wu YufeiSupervisor: Prof. Li KeqingAcademic Degree Applied for: Master of MedicineSpecialty: NursingUniversity: Hebei UniversityDate of Accomplishment: June, 2015摘要目的：引进布罗塞特暴力风险评估量表（Brøset-Violence-Checklist，BVC），并测定其中文版在中国精神疾病人群中的效度和信度，为我国精神科临床医护人员提供一个简短、准确、规范的暴力预测工具。

方法：1. 经原作者授权，按照：翻译一回译一文化调适一预实验的程序，汉化BVC量表。

2. 邀请从事精神科工作20年以上的5名专家（3名临床医生及2名护士）对该评估工具进行内容效度的评定，结果应用内容效度指数（Content V alidity Index ，CVI）表示。

3. 由本课题研究者对参与本研究的护士进行统一培训，9位经过培训合格的护士独立评估14个相同病例，采用组内相关系数（Intraclass Correlation Coefficient，ICC）评价该量表的评定者间信度。

4. 采用方便抽样方法，选取河北省第六人民医院556例诊断符合国际疾病和有关健康问题分类（第10版）诊断标准的各种精神障碍患者进行正式测试。

应用BVC-C每8 h对患者评估一次，应用修订版外显攻击行为量表（Modified Overt Aggression Scale，MOAS）检验BVC-C的同时效度；根据攻击真实结果检验BVC-C的预测效度；应用Cronbach α系数和题总相关性检验BVC-C的内部一致性信度。

5. 数据收集：应用EpiData软件建立数据库。

6. 统计分析：应用SPSS19.0软件对数据进行统计学处理。

结果：1. 量表回收：实际完成评估571例，其中2例基本信息不全，13例脱落，有效病例为556例，9个班次内收集有效评估表5004份。

2. 评估耗时：总体评定时间1~5（2.16±0.88）分钟，其中1228份（24.5%）在1分钟内完成、2030份（40.6%）在2分钟内完成、1491份（29.8%）在3分钟内完成、203份（4.1%）在4 分钟内完成、52份（1.0%）在5 分钟内完成。

3. 效度：（1）内容效度：量表的内容效度指数为0.93，表明量表的内容效度较好。

（2）同时效度：除自身攻击分量表外，MOAS总分及其他3个分量表得分与BVC-C总分及个项目得分均正相关（r=0.11~0.69，P<0.01），为低度至中度相关。

（3）预测效度：经分析8h的预测效度最佳，截断点为2分时，ROC曲线下面积AUC为0.98，工具的灵敏度为78.9%，特异度为95.1%。

4. 信度：（1）评定者间信度：BVC-C 6条目的组内相关系数（ICC）为混乱（0.90）、易激惹（0.82）、喧闹（0.82）、口头威胁（0.83）、躯体威胁（0.84）、毁物行为（0.93）、总分（0.93），均在0.8以上，提示经过培训不同评定者都能够正确掌握该调查工具。

（2）内部一致性信度：Cronbach α系数为0.76，表明量表各项目间的同质性较高。

（3）题总相关性：题总相关性是研究项目与总分的相关性，各项目与总分的相关性r=0.47~0.80（P<0.01），表明各项目是共同测量了总量表的特质或内容。

结论：BVC-C具有较好的效度和信度，同时也得到护理人员的高度认可，可以作为国内精神科暴力风险的有效预测工具，并可针对国情对BVC-C进行适当修订和完善。

关键词精神科危险性评估布罗塞特暴力风险评估量表效度信度AbstractObjective:To introduce the BVC scale and test the validity and reliability of the Chinese version of the Brøset-Violence-Checklist (BVC-C) in psychiatric populations in China, to provide a brief, accurate and normative violence prediction instrument for the psychiatric clinical staff in our country.Methords:1. With the authorizing permission by the author, according to the proceeding of translation—back translation—culture adaptation—preliminary test, the BVC was translated into Chinese version.2. Five psychiatry experts who have been worked more than 20 years were invited (three clinical doctors and two nurses) to evaluate the content validity of the scale, and the content validity index was used to indicate the result.3. The nurses who participated in this study were unified training by the researchers. 9 nurses who have passed the examination assessed 14 same cases independently, using the intraclass correlation coefficient (ICC) to evaluate the inter-rater reliability of the scale.4. Using the convenient sampling method, 556 inpatients from The Sixth People's Hospital of Hebei Province who met the diagnosis criteria for mental disorders according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) were totally selected to proceed the formal testing. The BVC-C was used to evaluate inpatients every 8 hours, and the Modified Overt Aggression Scale (MOAS) was used to test concurrent validity; the results of the actual attacking incidents were used to test the predictive validity; the internal consistency reliability of the scale was tested by Cronbach α coefficient and item total correlations.5. Data collection: To establish the database by using the EpiData software.6. Statistical analysis: Using the SPSS 19.0 software for data statistics processing. Results:1. Scale recycling: Actually, 571 patients were evaluated, the basic information of 2 cases were not complete, 13 cases were fall out, so the effective cases were 556, 5004 effective evaluation sheets were collected in the nine shifts.2. The time required for evaluation: The overall evaluation time were 1~5 (2.16 + 0.88) minutes, 1228 (24.5%) evaluation sheets were completed within 1 minute, 2030 (40.6%) evaluation sheets were completed within 2 minutes, 1491 (29.8%) evaluation sheets were completed within 3 minutes, 203 (4.1%) evaluation sheets were completed within 4 minutes, 52 (1.0%) evaluation sheets were completed within 5 minutes.3. V alidity: (1) Content validity: The content validity index of the scale was 0.93, it suggested that the scale had good content validity. (2) Concurrent validity: In addition to the own attack subscale, the MOAS total scores and the other three subscales scores were positively correlated with the BVC-C total scores and each item score (r=0.11-0.69, P<0.01), which were low to moderate correlation. (3) Predictive validity: The best predictive validity was eight hours through analyzed, when the cut-off was 2, the AUC was 0.98, the sensitivity and specificity were 78.9% and 95.1% respectively.4. Reliability: (1) Inter-rater reliability: The interclass correlation coefficient (ICC) for the six BVC-C items were: confusion, ICC=0.90; irritability, ICC=0.82; boisterousness, ICC=0.82; verbal threats, ICC=0.83; physical threats, ICC=0.84; attacks on objects, ICC=0.93; the ICC value for the total BVC-C socre was 0.93, all of the ICC values was above 0.8 indicated that different evaluators could grasp the assessment tool correctly after training. (2) Internal consistency reliability: The Cronbach α coefficient was 0.76, which showed that high homogeneity between each item of the scale. (3) Item total correlations: Item total correlations refers to the correlation between the research project and the total score, the item total correlations were r=0.47-0.80 (P<0.01), which showing that each item measured the properties or content of the scale together.Conclusion:It suggests that the BVC-C has good validity and reliability, and it also received highly approval of nursing staff at the same time. The BVC-C could be used as an effective prediction tool for psychiatric violence risk, and it can be revised and perfected appropriately according the national conditions.Key Words psychiatry risk assessment Brøset-Violence-Checklist validity reliability目录前言 .............................................................................................................................. - 1 -第1章中文版布罗塞特暴力风险评估量表的效度和信度检验.................................. - 4 -1.1背景............................................................................................................................................ - 4 -1.2内容与方法 ............................................................................................................................. - 5 -1.2.1研究对象 ....................................................................................................................... - 5 -1.2.2研究内容 ....................................................................................................................... - 6 -1.2.3研究方法 ....................................................................................................................... - 9 -1.3质量控制................................................................................................................................. - 14 -1.3.1量表设计阶段 ............................................................................................................ - 14 -1.3.2资料收集阶段 ............................................................................................................ - 14 -1.3.3资料整理与录入阶段............................................................................................... - 15 -1.4统计方法................................................................................................................................. - 15 -第2章结果............................................................................................................. - 16 -2.1纳入对象基本信息............................................................................................................... - 16 -2.2评估所用时间及攻击行为发生情况............................................................................... - 16 -2.3效度.......................................................................................................................................... - 16 -2.3.1内容效度 ..................................................................................................................... - 16 -2.3.2同时效度 ..................................................................................................................... - 17 -2.3.3预测效度 ..................................................................................................................... - 17 -2.4信度.......................................................................................................................................... - 18 -2.4.1评定者间信度 ............................................................................................................ - 18 -2.4.2内部一致性信度........................................................................................................ - 18 -第3章讨论............................................................................................................... - 19 -第4章结论............................................................................................................... - 21 -参考文献 ........................................................................................................................ - 22 -综述 ............................................................................................................................ - 25 -附录 ............................................................................................................................ - 37 -致谢 ............................................................................................................................ - 42 -攻读硕士学位期间取得的科研成果 .............................................................................. - 43 -前言工作场所暴力在全世界范围内普遍存在，已经成为影响各行各业的复杂问题，尤其是在卫生保健服务行业。