台灣青少年社交畏懼症評量表之發展

Abstract

背景：社交焦慮症為好發於青少年之常見精神疾病，其病程常為慢性化，且多合併憂鬱症、物質濫用及單純畏懼症、廣泛性焦慮症等其他焦慮疾患；對患者之生活品質、人際關係及職業功能等影響甚鉅，但易為患者與臨床醫師所忽視。因此，目前之防治策略多指向針對社區的青少年進行篩檢，並確立診斷，以便及早介入。 本研究之目的即為設計並修訂中文版之青少年自填社交畏懼症評量表，作為篩檢台灣青少年社交焦慮症之工具。 方法：於三所五年制專科學校抽取一至三年級學生共369名完成自填「台灣青少年社交畏懼症評量表」，其中333名再經由精神科醫師以中文版神經精神醫學臨床評估表(簡稱SCAN)進行會談，確立是否符合DSM-IV或ICD-10-DCR之社交畏懼症診斷，並依據檢測結果進行各種信度與效度評估。 結果：無論是17或22題版的「台灣青少年社交畏懼症評量表」都有良好的內在一致性與效標效度。就DSM-IV診斷系統而言，區別社交畏懼症患者與正常對照組之最佳臨界點分別為23 (17題版)與26 (22題版)分。鑑別分析結果顯示「害怕團體活動」、「避免演講」、「在別人面前會發抖、晃動」、「害怕自我介紹」、「害怕與陌生人以電話交談」及等五題有最佳鑑別力。另方面，就ICD-10-DCR診斷系統而言，其最佳臨界點與前述僅有些微差異，但以「會因臉紅而困擾」、「逃避尷尬情境」、「害怕與陌生人交談」及「在別人面前會發抖、晃動」等四題最具鑑別力。 結論：「台灣青少年社交畏懼症評量表」為信效度良好之篩檢工具。

Background: Social phobia (SP) is a common mental disorder with onset in adolescence. Most of the cases have a chronic course and are frequently comorbid with other mental disorders, such as depressive disorders, substance disorders and anxiety-spectrum disorders. In spite of the great impact on quality of life, interpersonal relationships and occupational functioning, the patients and clinicians usually neglect SP. To prevent the disorder, it is crucial to screen the susceptible subjects in the community and provide prompt intervention. Aims of the present study are to design and modify the self-administered Chinese Social Phobia Inventory for screening SP among Taiwanese adolescents. Method: Three hundred and sixty-nine subjects were recruited from the junior grades of three vocational colleges and completed the self-administered questionnaire. Diagnostic interviewing was conducted for 333 of the total participants by a psychiatrist with the Chinese version of Schedules of Clinical Assessment in Neuropsychiatry (SCAN) to identify the social phobic cases. Then, the psychometric properties were examined.

Result： Good internal consistency and criterion validity were obtained for both of the 17-item and 22-item versions of SPIN-TA. The optimal cut-off scores were 23 and 26 for DSM-IV definition, respectively. The items with best discrimination power were “fear of group activities”, “avoidance of speech”, “distressed by trembling or shaking”, ”fear of introducing oneself”, and ”fear of talking to strangers on phone”. There were similar cut-off points for cased defined by ICD-10-DCR, but the items with best discrimination were “bother by brushing”, “avoidance of embarrassment”, “fear of talking to strangers” and “distressed by trembling or shaking'.

Conclusions： SPIN-TA has been demonstrated to have satisfactory psychometric properties and can be employed as a screening tool for the detection of social phobia among Taiwanese adolescents in the community.