應用個案自陳資訊系統(PROMIS)的憂鬱，焦慮，生氣，睡眠困擾，以及睡眠相關障礙量表於台灣精神疾病患者之效度研究

Validity Study of The depression, anxiety, anger, sleep disturbance, and sleep related impairment scales of the PROMIS for Persons with Mental Illness in Taiwan

吳佳芳(Chia-Fang Wu)

指導教授 ： 潘璦琬

國立臺灣大學/醫學院/職能治療研究所/碩士(2018年)

https://doi.org/10.6342/NTU201803307

摘要

個案自陳成效資訊系統(Patient-reported outcome measurement information system, PROMIS) 已被廣泛使用並有多國語言翻譯版本，當中包含生理、心理及社會健康等領域，適用於精神疾患者主觀地表達與疾病健康相關的生活品質概況。本研究的目的即驗證中文版PROMIS憂鬱、焦慮、生氣、睡眠困擾和睡眠相關障礙等五份量表應用於台灣精神疾患者的效度。
本研究的樣本來源有二、其一來自於某醫學中心不同醫療層級之精神疾病患者(101位)參與研究，簡式智能量表≥24分方進行PROMIS五份量表及台大症狀量表。其二為來自於社區精神疾患者及健康者。總樣本數共720人，精神疾患者多半為思覺失調症(51.1%)及無業(68.7%)，平均年齡為45.45歲，健康者為27.93歲，就業者居多。運用羅序分析針對720位受試者進行量表之建構效度及項目差異功能分析。
本研究結果顯示除了PROMIS睡眠相關障礙量表1題嚴重違反項目單向度檢驗外，經調整後的PROMIS睡眠相關障礙量表為15題和其餘PROMIS量表皆具有良好的內在一致性和可接受的建構效度。PROMIS負向情緒量表各出現極少數的年齡DIF。PROMIS五量表具可接受的收斂效度及區辨效度，與生活品質分數及台大症狀量表達中度相關，五量表可區分不同症狀程度之精神疾患者。急性比日間病患明顯有睡眠困擾問題。
本研究結果顯示PROMIS憂鬱、焦慮、生氣、睡眠困擾量以及刪題後的睡眠相關障礙量表具有良好的內在一致性及建構效度，可用來測量精神疾患者以及健康者的情緒和睡眠相關的症狀問題。

關鍵字

個案自陳成效資訊系統 ； 憂鬱 ； 焦慮 ； 生氣 ； 睡眠困擾 ； 睡眠相關障礙 ； 羅序分析 ； 心理計量 ； 精神疾患

並列摘要

The Patient-reported outcome measurement information system (PROMIS) was developed to provide proper tools to measure quality of life related characteristics for persons with chronic illness. Many of its scales were translated into several languages and were applied in clinical work and research. The purposes of the study were to examine the validity of these five scales, including depression, anxiety, anger, sleep disturbance and sleep-related impairment.
Methods The study includes samples from two sources; one was collected from various ward settings of a medical center; the other one was from community setting including persons with mental illness and normal subjects. Therefore, a total of 720 subjects were collected. The subjects collected from the first source were collected on PROMIS scales, MMSE (>24) and a symptom checklist. The subjects collected from the second source were tested on PROMIS only. Both studies were approved by the institutioanl review board of related instititution (IRB-TPEVGH NO.:2017-06-001C). The data were analyzed with Rasch measurement model for construct validity. We also studied the convergent and discriminitive validity using traditional analysis.
Results- The five scales of PROMIS showed acceptable construct validity, which each scale demonstrated good fit to the Rasch model. The difficulty of the items were on target for all scales. The results showed acceptable convergence validity by correlating with life satisfaction and symptom checklist. Patients in acute ward have a severe sleep disturbance compared with those who stay in day ward.
Conclusions- The depression, anxiety, anger, sleep disturbance and the sleep-related impairment scale of PROMIS demonstrated acceptable internal consistency and construct validity. Based on the evidence, they can be used to measure mental health and sleep quality for persons with mental illness.

並列關鍵字

Patient-reported outcome measurement information system (PROMIS) ； depression ； anxiety ； anger ； sleep disturbance ； sleep related impairment ； Rasch Analysis ； Psychometrics ； Mental Disorders

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