Objectives: To provide a longitudinal evaluation tool based on the frequency of aggressive behavior for the aggression assessment of schizophrenia patients.
Methods: The Life History of Aggression was translated and revised to form the Life History of Aggression-Chinese Version (LHA-CV) based on 369 patients diagnosed with schizophrenia in the Chengdu community and compulsory medical institution. The reliability of LHA-CV was analyzed by means of split-half reliability, test-retest reliability and inter-evaluator consistency. The validity was analyzed by item analysis, construct validity and criterion validity.
Results: Item analysis found that LHA-CV had good homogeneity and discriminant validity. Exploratory factor analysis found that the Kaiser-Meyer-Olkin (KMO) test value was 0.80, and the Bartlett's sphericity test χ2=1 203.46 (P<0.05), and it revealed four factors including non-physical aggression, physical aggression, self-directed aggression and antisocial behavior/consequences. The factor loadings for all 11 items were greater than 0.40. Confirmatory factor analysis was performed on the factor model, Chi-square degree of freedom (χ2/df) was 3.61, root mean square error of approximation (RMSEA) was 0.07, goodness-of-fit index (GFI) was 0.92, comparative fit index (CFI) was 0.90, incremental fit index (IFI) was 0.90, and the discriminant validity of each factor was good. The criterion validity test showed the total score of LHA-CV was positively correlated with the aggressive behavior level of MacArthur Community Violence Instrument, the total score of Buss-Perry Aggression Scale, and the score of Antisocial Personality Disorder Subscale of Personality Diagnostic Questionnaire-4th Edition Plus (PDQ-4+_ASPD, P<0.05). The Cronbach's α coefficient of non-physical aggression, physical aggression, self-directed aggression, antisocial behavior/consequences and LHA-CV total score were 0.82, 0.73, 0.74, 0.56 and 0.79, respectively. The test-retest reliability, Spearman-Brown split-half reliability and intra-class correlation coefficient of LHA-CV total score were 0.82 (P<0.05), 0.66 and 0.99, respectively.
Conclusions: LHA-CV has good reliability and validity, and can be used as an evaluation tool for longitudinally assessing aggressive behavior in schizophrenia patients.
目的: 为精神分裂症患者攻击行为评估提供一种以攻击行为发生次数作为评分依据的纵向评估工具。方法: 对一生攻击史量表进行翻译并修订，形成一生攻击史量表中文版（Life History of Aggression-Chinese Version，LHA-CV）。基于成都市社区及强制医疗所共369例精神分裂症患者，采用分半信度、重测信度及评估者间一致性对LHA-CV的信度进行分析，采用项目分析、结构效度及效标效度进行效度分析。结果: 项目分析发现，LHA-CV整体的同质性与区分度较好。探索性因素分析发现，Kaiser-Meyer-Olkin（KMO）检验值为0.80，Bartlett球形检验χ2=1 203.46（P<0.05），析出非躯体攻击、躯体攻击、自我攻击和反社会行为/结果4个因子，11个条目的因子载荷均大于0.40。对该因子模型进行验证性因素分析，卡方自由度比（χ2/df）为3.61，近似误差均方根为0.07，拟合优度指数为0.92，比较拟合指数为0.90，增值拟合指数为0.90，各因子区分效度较好。效标效度检验结果显示，LHA-CV总分与MacArthur社区暴力工具评估的攻击行为等级、Buss-Perry攻击性量表总分、人格障碍诊断问卷（第4版）反社会型人格障碍分量表得分呈正相关（P<0.05）。LHA-CV的非躯体攻击、躯体攻击、自我攻击、反社会行为/结果以及总分的Cronbach’s α系数分别为0.82、0.73、0.74、0.56和0.79。LHA-CV总分的重测信度为0.82（P<0.05），Spearman-Brown分半信度为0.66，组内相关系数为0.99。结论: LHA-CV具有良好的信度与效度，可作为纵向测评精神分裂症患者攻击行为的评估工具。.
Keywords: Life History of Aggression-Chinese Version (LHA-CV); aggressive behavior; forensic psychiatry; reliability; schizophrenia; validity.