病気の自覚尺度(The Insight Scale日本語版)の信頼性・妥当性の検討

Reliability and Validity of a Japanese Version of the Markova-Berrios Insight Scale

抄録

　【背景】Markovaら(2003)の作成した病気の自覚尺度は統合失調症者の主観的体験の変化を患者と医療者で共有する手段として有効と考えた。【目的】病気の自覚尺度日本語版の信頼性と妥当性を明らかにする。【方法】統合失調症者104名に質問紙調査を行った。【結果】クロンバックα係数は0.84，級内相関係数は0.90だった。精神科専門家による妥当性の評価は低い項目もあったが，病気の自覚尺度とSAI-J，g12「判断力と病識の欠如」，PANSSの陽性尺度，陰性尺度で関連が認められた。【考察】病気の自覚尺度は十分な信頼性と一定の妥当性が示され，患者の主観的体験の変化を把握するのに有効な手段であることが示された。

　Introduction Evaluating insight of psychiatric patients is a problem. Many researchers have published tools for evaluation of insight；however, these tools cosider different aspects of insight. In 1992, Markova and Berrios published an insight scale and they restandardized their scale in 2003. The scale focuses on patients' awareness and expression of subjective experiences and can be used by medical professionals to share and understand the patients' subjective experiences. Aim：This study reports on the reliability and validity of a Japanese version of this scale. Method：We used the Japanese scale to examine the responses of 63 schizophrenic inpatients. Further we evaluated the validity of the scale with 18 medical professionals. Result：Cronbach's alpha coefficient was 0.84 and the interclass correlation was 0.90. Although some items of the scale showed low validity when examined by medical professionals with long experience of working in psychiatric hospitals, factor analysis identified 6 items that suggested subjective changes in the self and in interactive relationships between the self and the environment. Not only was the scale significantly correlated with the Japanese version of the Schedule for the Assessment of Insight and g12 “Luck of judgment and insight,” but also some the scale's items were related to the Positive and Negative Syndrome Scale. Discussion：Our findings suggest that the Japanese scale measures symptom-related items as well as patients' awareness and expression of subjective experiences. Thus, we conclude that the Japanese version of the insight scale proposed by Markova and Berrios has sufficient reliability and validity. Since subjective experiences are affected by the severity of symptoms, the Markova and Berrios insight scale can be used by medical professionals in Japan for measuring the changes in patients' subjective experiences during different stages of schizophrenia. Since this was a cross-sectional study, further examination of the Japanese version of the Markova and Berrios insight scale should be perfomed .