地震后斯坦福急性应激反应问卷最佳筛查阈值ROC分析
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摘要
目的:评估地震后第2周转移安置点灾民的急性应激障碍(ASD)。探讨斯坦福急性应激反应问卷(SASRQ)的最佳筛查阈值。方法:利用SASRQ对灾民223人进行评估,根据美国精神障碍诊断和统计手册第4版(DSM-IV)症状标准进行症状学分析,以此结果为状态变量,以SASRQ量表总分为检测变量得到ROC曲线,以曲线上约登指数最大点为SASRQ最佳筛查阈值。结果:16人(7.2%)符合DSM-IV的ASD症状学诊断标准。有分离症状69人(30.9%),创伤再体验症状98人(44.0%),回避症状70人(31.4%),焦虑或醒觉性增高症状117人(52.5%)。ROC曲线下面积0.907±0.021(95%CI:0.865～0.939),P<0.01。以SASRQ总分40分为阈值时约登指数最大(0.711),筛查敏感度为0.938,特异度为0.773。结论:地震后第2周灾民中ASD常见,40分可能是SASRQ的最佳筛查阳性阈值。
Objective:To assess acute stress disoder(ASD) symptoms and study the optimal cutoff value of Stanford acute stress reaction questionnaire(SASRQ) among victims of earthquake in temporary settlements.Methods:Two hundred and twenty-three victims were randomly chosen and measured by SASRQ.Then data were analyzed according to symptom criteria of DSM-IV ASD,and the result of symptomatology analysis was taken as actual state variable of ROC curve and total score of SASRQ as the test variable.The point on ROC curve having the highest Youden Index was considered as the optimal cutoff value.Results:Sixteen cases(7.2%) of victims met symptom criteria of DSM-IV ASD among victims.There were 69 cases(30.9%)with dissociative symptoms,98 cases(44.0%)with re-experiencing trauma,70 cases(31.4%)with avoidance and 117cases(52.5%)with arousal or anxiety.Area under the curve(AUC) of ROC was 0.907±0.021(95%CI:0.865～0.939),P<0.01.The point of 40 had the highest Youden Index of 0.771,and had a sensitivity of 0.938 and specificity of 0.773.Conclusion:ASD symptoms are common among victims in temporary settlements still the second week after Wenchuan Earthquake,and 40 may be the optimal cutoff value of SASRQ for screening ASD symptoms.
Objective:To assess acute stress disoder(ASD) symptoms and study the optimal cutoff value of Stanford acute stress reaction questionnaire(SASRQ) among victims of earthquake in temporary settlements.Methods:Two hundred and twenty-three victims were randomly chosen and measured by SASRQ.Then data were analyzed according to symptom criteria of DSM-IV ASD,and the result of symptomatology analysis was taken as actual state variable of ROC curve and total score of SASRQ as the test variable.The point on ROC curve having the highest Youden Index was considered as the optimal cutoff value.Results:Sixteen cases(7.2%) of victims met symptom criteria of DSM-IV ASD among victims.There were 69 cases(30.9%)with dissociative symptoms,98 cases(44.0%)with re-experiencing trauma,70 cases(31.4%)with avoidance and 117cases(52.5%)with arousal or anxiety.Area under the curve(AUC) of ROC was 0.907±0.021(95%CI:0.865～0.939),P<0.01.The point of 40 had the highest Youden Index of 0.771,and had a sensitivity of 0.938 and specificity of 0.773.Conclusion:ASD symptoms are common among victims in temporary settlements still the second week after Wenchuan Earthquake,and 40 may be the optimal cutoff value of SASRQ for screening ASD symptoms.
引文
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[4]DEMIR T,DEMIR DE,ALKAS L,et al.Some clinical characteristics of children who survived the Marmara earthquakes[J].Eur Child Adolesc Psychiatry,2010,19(2):125-133.
[5]MCKIBBEN JB,BRESNICK MG,WIECHMAN ASKAY SA,et al.Acute stress disorder and posttraumatic stress disorder:a prospective study of prevalence,course,and predictors in a sample with major burn injuries[J].J Burn Care Res,2008,29(1):22-35.
[6]宇传华.医学统计学[M].北京:人民卫生出版社,2002:172
[2]CARDEA E,KOOPMAN C,CLASSEN C,et al.P Psychometric properties of the Stanford Acute Stress Re-action Questionnaire(SASRQ):a valid and reliable measure of acute stress[J].J Trauma Stress,2000,13(4):719-734.
[3]宇传华,徐勇勇.ROC分析的基本原理[J].中华流行病学杂志,1998,19(5):434-415.
[4]DEMIR T,DEMIR DE,ALKAS L,et al.Some clinical characteristics of children who survived the Marmara earthquakes[J].Eur Child Adolesc Psychiatry,2010,19(2):125-133.
[5]MCKIBBEN JB,BRESNICK MG,WIECHMAN ASKAY SA,et al.Acute stress disorder and posttraumatic stress disorder:a prospective study of prevalence,course,and predictors in a sample with major burn injuries[J].J Burn Care Res,2008,29(1):22-35.
[6]宇传华.医学统计学[M].北京:人民卫生出版社,2002:172
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