摘要/Abstract
摘要： 目的·建立自杀能力评估量表，评价该量表在医学生中的信度与效度。方法·采用方便抽样的方法，对某医学院1 108名本科生进行测试。间隔2个月后对其中42名学生进行重测。使用SPSS 20.0和AMOS 22.0软件对数据进行统计学分析。采用Pearson相关系数和内容效度指数（content validity index，CVI）评价量表的内容效度；采用因子分析和独立样本t检验评价量表的结构效度和区分效度；采用内部一致性信度（Cronbach's α系数）、折半信度（Spearman-Brown系数）和重测信度[组内相关系数（intraclass correlation coefficient，ICC）]评价量表的信度。结果·1 094名测试对象的自杀能力评估量表平均得分为（21.02±10.86）分，其中308名（28.15%）有自杀意念，曾有自杀企图的68名，曾有自杀行为的38名。条目水平的内容效度指数（item-level CVIs，I-CVIs）均高于0.80，量表水平的内容效度指数（scale-level CVI，S-CVI）为0.97。各个分量表得分与其条目得分的相关系数r在0.842～0.916之间。Kaiser-Meyer-Olkin（KMO）抽样适当性参数为0.691，Barlett球形检验P<0.001，提示数据适合进行因子分析。应用主成分分析法，以特征值≥1，经方差最大正交旋转后，提取出3个公因子，累计方差贡献率达76.01%。经过模型修正后，验证性因子分析各项拟合指标均提示模型拟合结果良好[卡方自由度比（χ2/df）=3.652，近似误差均方根（root mean square error of approximation，RMSEA）=0.070，比较拟合指数（comparative fit index，CFI）=0.977，拟合优度指数（goodness of fit index，GFI） =0.979，规范拟合指数（normed fit index，NFI） =0.969，增量拟合指数（incremental fit index，IFI）=0.977]，且因子负荷均>0.6。有自杀企图组（33.85±11.42）总分高于无自杀企图组（27.60±9.35）（t=4.621，P=0.000），有自杀行为组（36.18±12.60）总分高于无自杀行为组（27.97±9.37）（t=3.870，P=0.000）。量表的Cronbach's α系数为0.794，Spearman-Brown系数为0.729，ICC为0.846。结论·自杀能力评估量表包含自我感知的自杀能力、对疼痛的忍受力和冲动性3个维度，在医学生中具有良好信度与效度。该量表对识别个体（尤其是有自杀意念的人群），是否具备自杀能力，防止其自杀行为的发生有一定意义。
关键词: 自杀, 能力, 信度, 效度, 医学生
Abstract:
Objective · To develop Acquired Capability for Suicide Scale and examine its reliability and validity in medical undergraduates. Methods · Convenient sampling was used. One thousand one hundred and eight medical students were selected and assessed with Acquired Capability for Suicide Scale, forty-two of which were reassessed after 2 months. SPSS 20.0 and AMOS 22.0 were used for analysis. Pearson correlation coefficient and content validity index (CVI) were used to examine the content validity; factor analysis and independent sample t-test were used to examine construct validity and differentiated validity. Reliability was assessed by internal consisitent reliability (Cronbach's α), split-half reliability (Spearman-Brown coefficient) and retest reliability (intraclass correlation coefficient, ICC). Results · The average score of Acquired Capability for Suicide Scale of the total 1 094 participants was (21.02±10.86). Three hundren and eight participants (28.15%) had suicide ideation, 68 had suicide attempt, and 38 used to have suicide behavior. Item-level CVIs (I-CVIs) were all higher than 0.80, and scale-level CVI (S-CVI) was 0.97. The correlation coefficients (r) of each subscale and its items ranged from 0.842 to 0.916. Kaiser-Meyer-Olkin (KMO) statistic was 0.691 and P value of Bartlett Test of Sphericity was less than 0.001, so the result showed the data was suitable for factor analysis. Principal component analysis and the maximum variance orthogonal rotation were used to extract 3 common factors with eigenvalue ≥ 1. The cumulative variance contribution rate was 76.01%. Each fitting index of the modified confirmatory factor analysis showed that the model fitted well [χ2/df=3.652, root mean square error of approximation (RMSEA)=0.070, comparative fit index (CFI)=0.977, goodness of fit index (GFI)=0.979, normed fit index (NIF)=0.969, incremental fit index (IFI)=0.977], and all the factors' loadings were over 0.6. The total score of suicide attempt group (33.85±11.42) was higher than that of non-suicide attempt group (27.60±9.35) (t=4.621, P=0.000), and the total score of suicide behavior group (36.18±12.60) was higher than that of non-suicide behavior group (27.97±9.37) (t=3.870, P=0.000). The Cronbach’s α coefficient of Acquired Capability for Suicide Scale was 0.794, the Spearman-Brown coefficient was 0.729, and ICC was 0.846. Conclusion · Acquired Capability for Suicide Scale includes 3 dimensions: self-perceived suicidal ability, impulsivity and tolerance of pain. The validity and reliability of Acquired Capability for Suicide Scale was good among Chinese medical undergraduates. The scale can be used to identify whether an individual, especially the people with suicide ideation, has the ability to commit suicide.
Key words: suicide, capability, reliability, validity, medical student
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