【作者】 张永东；

【导师】 赵虎；

【作者基本信息】 汕头大学 ， 精神病与精神卫生学， 2006， 硕士

【摘要】 背景及目的：创伤性事件所致的后果包括急性应激障碍或创伤后应激障碍，同时还有与精神创伤有关内心的和人际间的各种困难，这些统称为精神创伤。迄今，国内外仍缺少公认和客观的完整评价精神创伤严重程度的心理评定评估手段，使精神创伤严重程度的鉴定缺乏最基本的可比性和可重复性。本研究的目的就是编制出一套符合中国文化、适用普通人群的精神创伤影响评定问卷。 方法：首先，对精神创伤的概念进行界定，建立精神创伤影响问卷的维度构成，编制原始条目池。其次，选择120例近3个月来有精神创伤性事件史的当事人(应激组)作为预试人群，同时测查正常对照组59例。再次，根据心理测量学原理，对问卷进行质量分析。通过项目分析，完成对原始条目池的筛选和修改；通过因子分析进行结构效度检验，进一步对条目做出筛选和修改，构建命名新的因子；采用Cronbach’s alpha系数及半劈信度，对问卷进行信度分析。最后，编写正式的精神创伤影响评定问卷和工作用评定标准。 结果：(1) 精神创伤影响问卷共构建过度警觉、焦虑、抑郁、闯入性体验、防御性逃避、分离性症状、精神病性症状、紧张缓解行为、生理功能紊乱、社会功能损害等10个维度，并在此基础上编制条目词116条，形成预试量表。(2) 预试量表经过项目分析，因子分析，因子重新命名，共析出8个因子，分别是社会功能损害，警觉与焦虑，闯入性体验，生理功能紊乱，抑郁，分离性症状，防御性逃避，睡眠障碍。最终确定62个条目。(3) 精神创伤影响评定问卷总分与SCL-90的9个因子均有显著的正相关，相关系数在0.441～0.745不等。问卷总分与IES-R总分及闯入、回避、警觉因子相关系数分别为0.854，0.829、0.726、0.754，均为显著正相关。问卷抑郁因子与HAMD得分相关系数为0.602(P＜0.05)。问卷警觉与焦虑因子与HAMA得分相关系数为0.663(P＜0.05)。(4) 应激组和对照组在警觉与焦虑、生理功能障碍、抑郁、闯入、分离、回避、睡眠障碍、社会功能障碍等8个因子的差异均有显著性。(5) 修订后的量表经Cronbach’s alpha系数检验：8个分量表的内部一致性α系数分别为0.893，0.801，0.855，0.739，0.791，0.749，0.841，0.899，总量表的α系数为0.944。半劈信度检验：总量表的半劈信度为0.863，各层面半劈信度分别为0.813，0.797，0.766，0.794，0.737，0.572，0.766，0.882。(6) 前后两次施测精神创伤影响问卷，各层面(因子)相关系数为0.763～0.957，量表总分相关系数达0.880，均为显著性正相关。 结论：(1) 因子分析表明预想构建的理论架构基本合理，基本反映了精神创伤的维度构成。(2) 效标关联效度及判别效度分析显示，精神创伤影响问卷具有良好的效标效度和判别效度。(3) 信度分析显示本问卷具有良好的同质信度，重测信度结果显示问卷具有良好的稳定性。上述结果表明，精神创伤影响问卷适合用于精神创伤严重程度的量化评估。更多还原

【Abstract】 Background and objective:The consequence of traumaic event includes acute stress disorder (ASD), posttraumatic stress disorder (PTSD), the various kinds of intrapsychical and interpersonal difficulties. All these could be defined as psychological trauma. Nowadays, there have been seldom objective and authorized psychometric means to assess the severity of these symptoms. Many evaluations are lack of comparability and repeatability as well. This research aims to developing a set of psychological trauma impact questionnaire (PHIQ) which conforms to the Chinese culture and is suitable for the common population. Methods:Firstly, this study gave strict definition of psychological trauma, formulated the dimensions of PHIQ, and compiled preliminary items. Secondly, 120 samples suffered from psychic trauma events within 3 months acted as pretesting population (the stress group), while 59 healthy adults as the normal control group.Thirdly, the quality analysis of questionnaire was conduct according to principal of psychometrics, then the items were screened and revised based on item analysis. To verify construct validity and build new factors, factor analysis was carried out further, reliability analysis was made with Cronbach’s alpha coefficient and Split half reliability. Finally, PHIQ and the work-oriented evaluation standard were developed. Results:(1)10 dimensions such as Hyper arousal (H), Anxiety (a), Depression (D), Intrusive experiences (IE), Defensive avoidance (DA), Dissociation (DIS), Psychotic symptom (PS), Tension reduction behavior (TRB), Physiological dysfunction (PD), Social dysfunction, were established. 116 items were complied for the pretesting questionnaire. (2) The pretesting questionnaire was revised and reduced to be formal PHIQ with 62 items and 8 factors including SD, Arousal and anxiety (AA), IE, PD, D, DIS, DA and sleeping disorder (SD), by item analysis, factor analysis. (3) Criterion-Related validity: There is positive correlation between PHIQ total score and 9 factors of scl-90 (coefficient correlation with a range of 0.441 to 0.745). PHIQ total score is significantly positively correlated to total score, intrusive experiences factor, defensive avoidance and Hyper arousal factors of IES-R (γ=0.854, 0.829,0.726 and 0.754 respectively). Depression factor of PHIQ is significantly positively correlated to HAMD total score (γ=0.602, P<0.05). Anxiety factor of PHIQ is significant positively correlated to HAMA total score also (y =0.663, P<0.05). (4) Discrimination validity: The discrepancy between the stress group and control group is significant at 8 factors which are SD, AA, IE, PD, D, DIS, DA and SD. (5) Homogeneity reliability: Cronbach’s alpha coefficientt, the internal consistency alpha coefficient更多还原