症狀檢核表 90-修訂版 (SCL-90-R) 之台灣健康成人 常模研究

Abstract

背景：情緒症狀常伴隨腦部疾病，評估情緒症狀可協助減少情緒共病、簡化病人問題、舒緩病人困擾、和減輕照顧者的負擔。具良好性效度之衡鑑情緒困擾工具在鑑別診斷、治療計畫、和復健上具有臨床效用。症狀檢核表90-修訂版 (SCL-90-R) 被廣泛地用在神經科病人上以評估情緒困擾；然而，此檢核表缺乏台灣常模資料，其在台灣母群中之心理計量特性也未曾調查。目的：此研究之目的為建立症狀檢核表90-修訂版之台灣常模資料、檢驗常模適用性、評估人口學變相效果、和調查其心理計量特性。方法：本研究自社區招募356位具有代表性之健康具識字能力之成人參與者。參與者之家人或朋友提供對參與者之觀察。經過認知篩檢和簡短的面談，所有參與者在症狀檢核表90-修訂版上自填症狀評分；其家屬/朋友也在症狀檢核表90-修訂版上評量參與者的症狀。探索式和驗證式因素分析被用以檢驗其因素結構。兩個大小為30的子樣本被用以檢測在測信度和效度。本研究另外招募33位顳葉癲癇患者和各30位的由於阿茲海默症、巴金森氏症、和頭部創傷所致之極輕度至輕度失智患者，此病人樣本用以檢驗此檢核表之建構效度。結果：驗證式因素分析確認其手冊所載之九因素模型，但探索式因素分析只找到一因素代表一般性苦惱。症狀檢核表90-修訂版具好的內部一致性，且其可穩定的分類其向度上之症狀困擾程度。當情緒症狀明顯時，家人或朋友可提供可靠資訊。本研究驗證了症狀檢核表90-修訂版之體化、憂鬱、焦慮、一般性苦惱向度的效度，其他向度跟柯氏性格量表上有關之人格問題相關，提供間接的效度證據。檢核表中之強迫向度可能為心智低效率之指標。病人組與常模資料在向度上之比較符合文獻。此症狀檢核表具小的性別和教育人口學變相效果。本研究建立之常模具有適用性。結論：症狀檢核表90-修訂版可提供對於本地病人情緒症狀之重要臨床資訊，可作為評估受測者是否出現值得臨床關注之症狀的依據。

Background: Emotional symptoms come along with brain diseases. Evaluating emotional symptoms could help reduce the emotional comorbidity, simplifying the patients’ problems, alleviating their distresses, and easing the caretakers’ burden. Appropriate tools with good reliability and validity to assess emotional disturbances have clinical utility in differential diagnosis, treatment plan, and rehabilitation. Symptom Checklist-90-Revised (SCL-90-R) is widely used in neurologic patients to evaluate their emotional disturbances. However, lack of Taiwanese normative data limits the use of the SCL-90-R, and the psychometric properties have not been explored with Taiwanese data. Objectives: The objectives of the research are to establish the Taiwanese normative data of the SCL-90-R, to examine the appropriacy of the norm, to assess the demographic effects, and to examine the psychometric properties. Methods: The study recruited 356 participants representative of healthy literate adult Taiwanese population from the community. The family members or friends of the participants were also recruited as the informants. After the cognitive screening tests and short interview, all the participants and the informants filled the SCL-90-R. Exploratory and confirmatory factor analyses were used to examine the factor structures. Two subgroups of sample size of 30 were used to test the test-retest reliability and the validity. The study recruited 33 patients with temporal lobe epilepsy and 90 patients with very mild to mild dementia with Alzheimer’s disease, Parkinson’s disease, and traumatic brain injury for investigating the construct validity. Results: The CFA corroborated the original nine-factor solution, but the EFA only found one factor of general distress. The SCL-90-R had good internal consistency, and it could reliably classify the level of distress over time. The informants could provide reliable information when the symptoms are obvious. The SCL-90-R dimensions measuring somatic, depressive, anxiety, and general distress symptoms were validated, and the other dimensions correlated with corresponding problematic personalities measured by the Ko's Mental Health Questionnaire, providing indirect validating evidence. The obsessive-compulsive dimension of the SCL-90-R might be an index of mental inefficiency. The differences between the patient groups and the normative data were consistent with the literature. The gender and education effects were only small. The normative data has sound appropriacy. Conclusion: The SCL-90-R could provide important clinical information about patients’ emotional symptoms in Taiwan, and it could provide base rate information regarding the symptom domains.