广泛性焦虑量表中文版在中医内科门诊人群应用的信度和效度_曾庆枝
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·心身医学·广泛性焦虑量表中文版在中医内科门诊人群应用的信度和效度*曾庆枝何燕玲刘寒缪菊明陈建新徐海楠王静夷（上海交通大学医学院附属精神卫生中心，上海200030通信作者：何燕玲heyl2001@）【摘要】目的：评估7个症状条目的广泛性焦虑量表（GAD-7）中文版在中医内科门诊患者中筛查焦虑障碍的信度和效度，并确定其筛查临界值，为该量表在人群中的应用提供科学依据。
方法：中医内科门诊2011例18 65岁的患者完成GAD-7自评和一般资料信息采集后，采用简明国际神经精神访谈（M.I.N.I.）（中文版）进行抑郁障碍和焦虑障碍模块的精神诊断性评估，以信度分析、探索性因素分析、受试者工作特征曲线和方差分析来评估GAD-7的信度和效度。
结果：GAD-7的内部一致性Cronbachα系数为0.91，条目间的相关系数为0.52 0.68，条目与总分之间的相关系数为0.75 0.85（均P＜0.001），任一条目删除后α系数仍在0.89 0.90之间。
因素分析显示该量表为一因子结构（解释方差64.7%）。
ROC曲线分析显示曲线下面积（AUC）以广泛性焦虑症最大（AUC=0.88），惊恐障碍次之（AUC=0.80），场所恐惧症最小（AUC=0.63）。
以6分作为筛查临界值，GAD-7筛查广泛性焦虑障碍的灵敏度和特异度分别为0.86和0.76，惊恐障碍分别为0.78和0.74，场所恐惧症和混合性焦虑抑郁障碍的灵敏度分别为0.50和0.61，特异度均为0.73左右。
有抑郁障碍、各类焦虑谱系障碍和慢性躯体疾病患者的GAD-7评分均高于无相应诊断的患者（均P＜0.05）。
GAD-7评分越高，患者看医生次数越多（无焦虑、轻度、中度和重度焦虑患者分别为8.09、8.34、13.45和11.97次），因躯体或情绪原因缺勤的时间越长（依次为7.78/1.46、15.13/7.17、40.27/26.62和51.65/59.89天），与焦虑症状相关的困难程度越高（依次为0.1%，1.3%、17.3%和60.6%）（均P＜0.001）。
结论：广泛性焦虑量表中文版对广泛性焦虑障碍和惊恐障碍的筛查具有较高的信度和效度，值得推广使用，但不适合用于筛查场所恐惧症和混合性焦虑抑郁障碍。
【关键词】广泛性焦虑量表；信度；效度；受试者工作特征曲线中图分类号：R749.72文献标识码：A文章编号：1000－6729（2013）003－0163－06doi：10.3969/j.issn.1000－6729.2013.03.001（中国心理卫生杂志，2013，27（3）：163－168.）Reliability and validity of Chinese version of the Generalized Anxiety Disorder7-item(GAD-7)scale in screening anxiety disorders in outpatients fromtraditional Chinese internal departmentZENG Qing-Zhi，HE Yan-Ling，LIU Han，MIAO Ju-Ming，CHEN Jian-Xin，XU Hai-Nan，WANG Jing-Yi Shanghai Mental Health Center，Shanghai Jiao Tong University School of Medicine，Shanghai200030，ChinaCorresponding author:HE Yan-Ling，heyl2001@【Abstract】Objectives:To evaluate the reliability and validity of a Chinese version of the7-item Generalized Anxiety Disorder(GAD-7)scale in screening out anxiety disorders and to identify the cut-off score for screening anxiety in outpatients from traditional Chinese internal department，thereby providing scientific evidence for its im-plication.Methods:Totally2011patients aged18－65years old were selected from an internal department of tradi-tional Chinese medicine.They were assessed with the GAD-7and interviewed with the Mini International Neuropsy-*基金项目：上海市卫生局项目（2010105）chiatric Interview(M.I.N.I.).Internal consistency，explosive factor analysis，receiver operating characteristic curve(ROC)，and variance analysis were used to evaluate the reliability and validity of GAD-7.Results:The Cron-bach＇s coefficient of GAD-7was0.91，and the range of correlation coefficient within the7items and between items and the total score of the scale was0.52－0.68and0.75－0.85，respectively(P＜0.01).The Cronbach＇s coeffi-cients were stable when any of the7items had been deleted.The scale was shown to be one dimensional through factor analysis(explained variance=72%).The results of ROC analysis indicated that the area under the curve (AUC)was very good for both the generalized anxiety disorder(for GAD，AUC=0.88)and panic disorder(for panic disorder，AUC=0.80)，but not for agoraphobia(for agoraphobia，AUC=0.63).A cut point of6showed ad-equate values of sensitivity and specificity for GAD(0.86，0.76)，and panic disorder(0.78，0.74)，while inade-quate for agoraphobia(0.50，0.73)or mixed anxiety-depressive disorder(0.61，0.74).The GAD-7scores were higher in patients with depressive disorders，any anxiety disorders or chronic physical conditions than in those with-out(P＜0.05).There was a strong association between increasing GAD-7severity scores and health service utiliza-tion or worsening function.And for outpatients without anxiety，or with mild，moderate and severe anxiety severity score，the doctor visits were8.09，8.34，13.45and11.97times，the loss days due to physical reasons or mood rea-sons were7.78/1.46，15.13/7.17，40.27/26.62and51.65/59.89days，and the proportion of patients with symp-tom-related difficulty was0.1%，1.3%，17.3%and60.6%，respectively.Conclusion:It suggests that the GAD-7 is a reliable and valid measure for generalized anxiety disorder or panic disorder in outpatients from traditional Chi-nese internal department，and may be a valuable clinical and research tool for further implication，while may be not good enough for agoraphobia or mixed anxiety-depressive disorders.【Key words】7-item Generalized Anxiety Disorder scale(GAD-7);reliability;validity;receiver operating characteristic curve(Chin Mental Health J，2013，27(3):163－168.)广泛性焦虑障碍是综合性医院就诊人群中最常见的焦虑障碍之一，国内综合医院的现患率约为1.5% 4.2%［1-2］，国外更高［3］。
尽管有研究显示焦虑障碍对生活质量和社会功能的影响高于抑郁障碍［4］，但受关注程度远低于抑郁症。
2006年，Spitzer等［5］开发了7个症状条目的广泛性焦虑量表（7-tiem Generalized Anxiety Disorder Scale，GAD-7），因其信效度较高，简单易操作，已经广泛应用于科研和临床。
