Parmi les diagnostics de troubles anxieux auprès de la population ayant une déficience intellectuelle (DI), le trouble d’anxiété de séparation figure parmi les plus fréquents. Près de 30 à 50 % des personnes avec une déficience intellectuelle (DI) présentent également un trouble de santé mentale en comorbidité, dont les troubles anxieux. Sachant que la prévalence de la DI est de 1,0 % à 2,6 % de la population du Québec, il semble pertinent d’offrir des services adaptés à leurs besoins particuliers. Pourtant, la grande majorité des recherches portant sur des interventions pour réduire les symptômes anxieux auprès d’une population ayant un trouble neurodéveloppemental, tel que le trouble du spectre de l’autisme (TSA), exclut les participants ayant une DI. Pour répondre à ce besoin, ce projet de recherche visait à évaluer l’efficacité d’un programme d’intervention auprès d’un parent d’un enfant âgé de 8 ans ayant une DI et un trouble d’anxiété de séparation. Dans le cadre d’un devis à cas unique de type AB, nous avons mesuré les comportements anxieux tout au long du programme d’intervention mis en place. Les résultats montrent que certains symptômes anxieux ont diminué suivant l’implantation par le parent de stratégies cognitivo-comportementales. D’autres études devront être effectuées afin d’explorer davantage l’efficacité de ce programme. / Among the diagnoses of anxiety disorders in the population with intellectual disabilities (ID), separation anxiety disorder is the most common. About 30 to 50% of people with intellectual disabilities (ID) also have a comorbid mental health problem, including anxiety disorders. Knowing that the prevalence of the disease is from 1.0% to 2.6% of the population of Quebec, it seems relevant to offer services tailored to their specific needs. Yet, the vast majority of research has been done on interventions to reduce the symptoms of the population with a neurodevelopmental disorder, such as the autism spectrum disorder (ASD), excludes participants with an ID. To address this need, this research project was designed to evaluate the effectiveness of an intervention program with a parent of an 8-year-old child with ID and separation anxiety disorder. As part of a single-case AB type design, we measured anxiety behaviors throughout the intervention program set up. The results show that some anxiety symptoms have decreased following the parent's implementation of cognitive-behavioral strategies. Other studies should be done to explore the effectiveness of the program.

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Nights in The City Beautiful is a collection of confessional, free verse poems that explores sexual trauma, mental health, the exigencies of marriage, and the complexities of human desire. These interconnected poems are grounded with a braided narrative and tackle taboo themes. In Part 1: Monogamy, the reader journeys into the world of Vincent and Victoria, their profound love, and their anxiety disorders. In Part 2: Polyamory, Victoria gets caught in a love triangle when she meets her publishing coworker, Peter Langley. The book evokes the movement of Romanticism and first-and-second-generation Romantic poets such as William Blake and Lord Byron. Contemporary influences on this collection include Aaron Smith’s Primer, Stacey Waite’s Butch Geography, and Tracy K. Smith’s The Body's Question. Nights in The City Beautiful merges lyricism with narrative, the ethereal with the physical. It is a novella in verse that delves into the boundaries of sexuality, love, and intimacy.

Hintergrund. In klinischen und epidemiologischen Untersuchungen wurden retrospektiv Assoziationen zwischen Angst- und Alkoholstörungen bestätigt. Bei Personen, die von beiden Störungen betroffen waren, fand man restrospektiv meist einen früheren Beginn der Angststörungen im Vergleich zu den Alkoholstörungen, was kausal im Sinne der Selbstmedikationshypothese interpretiert wurde. Diese konnte bisher nicht eindeutig bestätigt werden. Zur Aufklärung notwendige prospektive Untersuchungen, die Angststörungen auf diagnostischer Ebene erfassen, zwischen verschiedenen Angststörungen unterscheiden und sich auf Jugendliche beziehen, fehlen bisher. Fragestellung. Die Bedeutung von Angststörungen für die Entwicklung von erhöhtem Alkoholkonsum und Alkoholstörungen bei Jugendlichen und jungen Erwachsenen. Methodik. Die Analysen basieren auf den Daten der prospektiv-longitudinalen EDSP-Studie (Follow-Up: insg. 4 Jahre) mit einer epidemiologischen, repräsentativen Stichprobe von 3021 Personen im Alter zwischen 14 und 24 Jahre zu T0 aus München und Umland. Zur Erhebung von DSM-IV-Diagnosen wurde das M-CIDI verwendet. Ergebnisse. Primäre Panikstörungen, Panikattacken und Soziale Phobie erwiesen sich prospektiv als spezifische Prädiktoren für Beginn und Aufrechterhaltung von Alkoholproblemen. Umgekehrt waren Alkoholprobleme mit einem erhöhten Risiko für den Beginn von Sozialer Phobie und GAS assoziiert. Bezüglich DSM-IV Diagnosekriterien fanden sich phobische Ängste sowie Episoden intensiver Angst als Risikofaktoren für den Beginn von Alkoholproblemen. Vermeidungsverhalten war mit einem verminderten Risiko für nachfolgende Alkoholprobleme verbunden. Schlussfolgerungen. Maßnahmen zur Prävention von Alkoholproblemen können sich zielgruppenorientiert an Jugendliche mit Sozialer Phobie und Paniksymptomatik richten. Bei Patienten, die sich wegen Alkoholproblemen in Behandlung begeben, ist eine umfassende Diagnostik zur Identifikation zusätzlicher Angststörungen ratsam. / Background. Many clinical and epidemiological studies have documented significant cross-sectional comorbidities between anxiety disorders and alcohol use disorders. Analysis of retrospective age-of-onset reports suggests that the anxiety disorders often start earlier than the alcohol disorders. These data have often been interpreted in terms of a self-medication-model implying a causal mechanism. Overall, in former studies this model couldn't definitely be proofed. Prospective studies that follow a sample of adolescents into adulthood assessing different anxiety disorders on an diagnostic level are needed to confirm these associations. Methods. Baseline and four-year-follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the M-CIDI. Results. While in retrospective analyses strong associations between nearly all anxiety disorders and alcohol problems, especially harmful use and dependence, were found, prospective analyses showed that only primary panic disorder, panic attack and social phobia are specific predictors of subsequent onset and persistence of alcohol problems. Contrary, primary alcohol problems were related to subsequent onset of social phobia and GAD. Considering the different DSM-IV-criteria, phobic anxiety as well as episodes of intensive anxiety were found to be risk factors for the following onset of alcohol problems. Avoidance behavior was associated with a lower risk for subsequent alcohol problems. Conclusions. Alcohol prevention programs could be directed to target groups with social phobia and panic. Patients with alcohol problems should carefully be screened for comorbid anxiety disorders. In order to prevent relapses the treating of social phobia and panic should be part of the therapy with comorbid alcohol patients.

Background Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. Method Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. Results Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses. Conclusions CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Generalized anxiety disorder (GAD) is frequently found in primary care settings and is highly prevalent among adolescents. The purpose of this study was to examine the cost effectiveness by provider type and therapy modality in treating adolescents (ages 13-17) with a GAD diagnosis (DSM-IV 300.02). A national insurance company in the United States provided outpatient and unidentifiable data for adolescent GAD cases (n = 2,932). These cases were used to analyze the cost effectiveness, total cost, treatment length, dropout, and readmission rates for the treatment of adolescents with GAD. Descriptive statistics signify that the mean cost of treatment for GAD in the first episode of care across all provider types is $439.28. Results revealed significant differences in cost effectiveness, total cost, treatment length, and readmission rates by provider type and therapy modality. MFTs and counselors were most cost effective, had the lowest total cost and number of sessions, as well as the lowest readmission rate among the provider types. In contrast, MSWs and psychologists were the least cost effective, had the highest number of sessions and the highest readmission rate. Therapy modality comparisons indicated that family therapy is most cost effective followed by individual, then mixed therapy modalities. Significantly fewer sessions were found when conducting family therapy upon treating adolescents with GAD. There were no significant differences in dropout by provider type, therapy modality or age group. The results of total cost by gender were also insignificant. Professional and clinical implications and future directions for research will be discussed.

Social Anxiety Disorder (SAD) and, more generally, social fears are common in young people. Although avoidance behaviors are known to be an important maintaining factor of social anxiety, little is known about the severity and occurrence of avoidance behaviors in young people from the general population, hampering approaches for early identification and intervention. Symptoms, syndromes, and diagnoses of DSM-5 mental disorders including SAD were assessed in a random population-based sample of 14-21-year-olds (n = 1,180) from Dresden, Germany, in 2015/2016 using a standardized diagnostic interview (DIA-X-5/D-CIDI). An adapted version of the Liebowitz Social Anxiety Scale was used to ascertain the extent of social fears and avoidance. Diagnostic criteria for lifetime SAD were met by n = 82 participants, resulting in a weighted lifetime prevalence of 6.6%. Social anxiety was predominantly reported for test situations and when speaking or performing in front of others. Avoidance was most prevalent in the latter situations. On average, anxiety and avoidance first occurred at ages 11 and 12, respectively, with avoidance occurring in most cases either at about the same age as anxiety or slightly later. In the total sample, lifetime prevalence for most DSM-5 disorders increased with the severity of social anxiety and avoidance. Results underline the need for preventive or early intervention efforts especially regarding test anxiety and fear and avoidance of speaking in front of others. These situations are particularly relevant in youth. Avoidance behaviors may also be discussed as diagnostic marker for early case identification.

Le trouble d’anxiété généralisée (TAG) demeure l'un des troubles anxieux les plus courants chez les personnes âgées. Bien qu'il existe des traitements pharmacologiques et psychologiques efficaces, des études suggèrent que le TAG soit sous-traité chez les personnes âgées puisque l’accès à la thérapie leur serait plus difficile. Afin d’augmenter l’accessibilité, des auto-traitements guidés permettant à la personne d’apprendre de manière autonome, à domicile, ont été développés. Toutefois, les recherches antérieures soulignent la nécessité d’examiner les variables prédictives pour déterminer qui bénéficie de ces traitements auto-guidés, considérant le peu d’informations disponibles sur les individus bénéficiant de telles interventions. De plus, l'efficacité à long terme des auto-traitements guidés n'a pas encore été démontrée de manière concluante. Ce problème est d'autant plus important chez les personnes âgées. Il est donc essentiel, pour une bonne application clinique, d'acquérir des connaissances sur les prédicteurs de résultats afin d’identifier les personnes susceptibles de répondre à ces types d'interventions. Par conséquent, cette thèse vise à développer une compréhension plus détaillée de la façon dont différentes variables sont associées à différentes mesures de résultats cliniques chez les personnes âgées, tant à court terme qu'à long terme, afin de faciliter les applications cliniques futures. Les données utilisées dans la présente thèse proviennent d'un essai contrôlé randomisé de plus grande envergure, conçu pour déterminer l'efficacité d'un auto-traitement guidé de 15 semaines pour traiter le TAG chez les personnes âgées, basé sur les principes de la thérapie cognitivo-comportementale (GSH-CBT) et guidé par des non-professionnels. La première étude a examiné les variables démographiques, motivationnelles et psychologiques qui ont prédit les résultats cliniques et l'abandon du traitement GSH-CBT en utilisant les données de 106 adultes âgés de 60 ans et plus. Les résultats cliniques comprenaient l'anxiété, l'inquiétude et l'intolérance à l'incertitude, mesurées respectivement par le GAD-7, le PSWQ et l'IUI. Une anxiété moins importante et une plus grande confiance vis-à-vis du traitement ont permis de prédire de meilleurs résultats post-traitement sur le GAD-7, tandis des inquiétudes moins intenses, une plus grande confiance dans le traitement et des attentes de résultats plus élevées ont permis de prédire de meilleurs résultats sur le PSWQ. Enfin, un niveau plus faible d'intolérance à l'incertitude et d'inquiétude, une plus grande motivation externe pour débuter le traitement, une meilleure perception de la crédibilité de la thérapie et des attentes de résultats plus élevées ont permis de prédire de meilleurs résultats sur l'IUI. Dans les analyses multivariées, seuls les niveaux initiaux d'anxiété, d'inquiétude et d'intolérance à l'incertitude permettaient de prédire l'issue du traitement. La seconde étude visait à déterminer quels facteurs prédisaient l'efficacité à long terme de ce traitement en examinant différentes variables qui prédisaient les mêmes résultats cliniques six mois et douze mois après le traitement, en utilisant les données de 26 adultes âgés de soixante ans et plus. Dans les analyses multivariées, des niveaux moins élevés d'anxiété, d'inquiétude et d'intolérance à l'incertitude, ainsi qu'une plus grande motivation externe, ont permis de prédire les résultats six mois après le traitement, tandis qu'un niveau moins élevé d'anxiété et une plus grande satisfaction à l'égard du soutien social ont permis de prédire les résultats douze mois après le traitement. L’ensemble de ces résultats révèle qu'une sévérité initiale des symptômes plus faible prédit un meilleur résultat du traitement, et que ce traitement peut être plus bénéfique à long terme pour les personnes âgées ayant des niveaux légers à modérés d'anxiété, d'inquiétude et d'intolérance à l'incertitude, motivées à suivre le traitement et ayant un plus grand niveau de satisfaction en matière de soutien social. / Generalized anxiety disorder (GAD) remains one of the most common anxiety disorders in older adults. Although effective pharmacological and psychological treatments are available, studies suggest that GAD is still undertreated in seniors because access to therapy is particularly difficult for older individuals. To increase accessibility, guided self-help treatments where the person learns autonomously from home have been developed. However, previous research highlights the need for more effective targeting through the determination of predictor variables to determine who benefits from these treatments, as little is known about which individuals benefit from guided self-help interventions. Furthermore, there is inconclusive evidence regarding the long-term effectiveness of guided self-help treatments. This issue is compounded with regards to older adults, thus gaining knowledge on outcome predictors to properly distinguish who is likely to respond from these types of interventions is vital to its proper clinical application. Therefore, this thesis focuses on developing a more detailed understanding of how different variables are associated with different measures of clinical outcomes in older adults both in the short-term and in the long-term to facilitate future clinical applications. The data used in the current thesis originates from a larger multisite randomized controlled trial designed to determine the efficacy of a 15-week guided self-help treatment of threshold and subthreshold GAD in older adults based on the principles of cognitive-behavioral therapy (GSH-CBT) and guided by lay providers. The first study examined the demographic, motivational, and psychological variables that predicted clinical outcomes and treatment dropout in this GSH-CBT using data from 106 older adults aged sixty years and over. Clinical outcomes included anxiety, worry, and intolerance of uncertainty measured by the GAD-7, PSWQ, and IUI respectively. Lower anxiety severity and higher confidence in the treatment predicted better post-treatment outcomes on the GAD-7, whereas lower worry severity, higher confidence in the treatment, and higher outcome expectations predicted better outcomes on the PSWQ. Lastly, lower intolerance of uncertainty and worry severity, greater external motivation for starting the treatment, greater perceived credibility of the therapy, and higher outcome expectations predicted better outcomes on the IUI. In multivariate analyses, only initial anxiety, worry, and intolerance of uncertainty severity predicted treatment outcome. The second study sought to determine which factors predicted the long-term efficacy of this treatment by examining different variables that predicted the same clinical outcomes at 6- and 12-months post-treatment using data from 26 older adults aged sixty years and over. In the multivariate analyses, lower initial anxiety, worry, and intolerance of uncertainty severity, as well as greater external motivation predicted treatment outcome at 6-months post-treatment, and lower initial anxiety and social support satisfaction predicted treatment outcome at 12-months post-treatment. Overall, the results of this thesis suggest that lower initial symptom severity predicts better treatment outcome, and that this treatment may be more beneficial in the long-term to older individuals with mild to moderate anxiety, worry, and intolerance of uncertainty, who are motivated to do the treatment and who have greater social support satisfaction.

Deux articles ont été publiés suite à ce mémoire de maîtrise. Un prix pour la meilleure affiche faite par un étudiant du département de psychiatrie de l'Universtité de Montréal a été obtenu suite à la présentation de résultats préliminaires à la Journée annuelle du Centre de recherche de l’Institut Universitaire en santé mentale de Montréal. Un support financier et des bourses ont été également accordés. Par exemple: Bourse d’excellence pour la recherche en psychiatrie, bourse du Cinquantenaire, Faculté de médecine, Département de psychiatrie, Université de Montréal; Bourse d’excellence du directeur de recherche, Centre d’études sur les troubles obsessionnels compulsifs et les tics- CETOCT; Centre recherche de l’Institut universitaire en santé mentale de Montréal; Bourse de Dépannage de la Faculté de médecine ainsi qu'une bourse de rédaction, Faculté de médecine de l’Université de Montréal, Montréal (QC). / Les troubles anxieux représentent les problèmes de santé mentale les plus répandus. Ils affectent 12% de la population, causent un handicap léger à grave et peuvent représenter un lourd fardeau pour les patients et leurs proches. Ils entrainent un impact économique majeur pour la société en termes d’utilisation accrue des services de santé tant psychiatriques que non psychiatriques, de diminution de productivité au travail, d’absentéisme et du chômage. Cette étude de type série de cas, décrit une stratégie d’augmentation ou de facilitation du changement en psychothérapie basée sur l’amorçage (priming) préconscient et son utilisation dans le traitement de huit patients souffrant de troubles anxieux. Les patients avaient manifesté une réponse symptomatique partielle à la thérapie cognitive-comportementale (TCC) malgré une bonne adhésion au traitement. La démarche d’augmentation de la psychothérapie par amorçage préconscient (APAP) comporte six étapes permettant d’établir des formulations cognitives adaptées à la problématique résiduelle personnelle du patient. Ces formulations sont enregistrées et masquées par une musique relaxante. Les patients ont écouté cet enregistrement dans un état d’inattention pendant 20 minutes deux fois par jour durant huit semaines. L’effet de cette stratégie a été évalué par des mesures de type quantitatif et qualitatif, des mesures auto rapportées par les patients par rapport aux changements cognitifs idiosyncratiques ainsi que par un questionnaire sur la qualité de vie. Les résultats élaborés par une analyse descriptive incluant une exploration de la signification statistique et clinique des effets observés montrent, que la stratégie d’amorçage préconscient est associée à des changements cognitifs favorables, à une diminution du discours intérieur négatif et problématique chez sept patients sur huit. Ces bienfaits ont été également maintenus à la 24ème semaine. Une nette amélioration clinique des symptômes anxieux et du fonctionnement global a été observée chez deux patients qui souffraient uniquement d’un trouble anxieux versus les six autres qui présentent une comorbidité additionnelle à leur diagnostic primaire. Ces derniers ont quand même vu une amélioration de leur qualité de vie comparativement à leur état avant de recevoir la stratégie APAP. L’émergence de pensées et d’attitudes positives et la diminution des pensées dysfonctionnelles observées chez la majorité des patients à la suite du traitement par APAP, suggère un impact favorable de l’intervention. La démarche APAP qui est accessible par Internet pourrait constituer un ajout au traitement par TCC en facilitant ou en augmentant le changement cognitif et symptomatique. / Anxiety disorders represent some of the most common mental health problems. These disorders affect up to 12% of the population causing mild to severe impairment and a potentially heavy burden for patients and their families. In addition, these disorders have a major economic impact on society in terms of increased use of health services both psychiatric and non- psychiatric, lower work productivity, absenteeism and unemployment. The current paper is a case series describing a new method for facilitating change based on Psychotherapy Augmentation through Preconscious Priming (APAP) and its use in the treatment of eight patients suffering from an anxiety disorder. Previously, the patients had shown only a partial response to CBT despite good adherence to treatment. Following this treatment, the patients completed the APAP process, which consisted of six steps during which alternative, more functional thoughts and beliefs were formulated, relevant to the idiosyncratic difficulties experienced by the patients. Subsequently, these formulations were recorded and mixed with masking relaxing music, following which the patient listened to the recordings in a passive state twice daily for 20 minutes for a period of 8 weeks. The effect of this strategy was evaluated by quantitative and qualitative measures administered before treatment with the APAP program, at 8 weeks, 16 weeks and 24 weeks. In addition, idiosyncratic ratings of dysfunctional thoughts, symptoms of anxiety, global functioning and quality of life were assessed at baseline and at 24 weeks. Results showed a significant reduction in dysfunctional thoughts reported by most patients treated with this method. There was substantial clinical improvement in anxiety symptoms both for patients who presented with and without co-morbid psychological disorders. Those with co-morbid psychological disorders who did not have a good quality of life at the start of treatment reported an increase in quality of life following treatment with APAP. In addition, a descriptive analysis of the results supported the notion that a preconscious priming strategy is associated with positive cognitive change with a reduction in negative thoughts in 7 out of 8 patients, which were maintained in the longer term. Further, this descriptive analysis suggested that patients who suffered from an anxiety disorder without co-morbidity showed more clinically significant improvement in anxiety symptoms and improved global functioning in comparison to those who presented with a co-morbid disorder. Overall, results suggested that the APAP intervention had a positive impact on the patients. Results showed that APAP led to positive cognitive changes in all patients and clinically significant improvement in anxiety symptoms and global functioning in patients without additional comorbidities. APAP could be a valuable addition to CBT by facilitating or enhancing cognitive and symptom change.

本研究旨在探討「健康、性格、習慣量表(HPH)」的臨床效度。HPH最初是由柯永河教授(民84)編製，後來廣泛使用在國內臨床場域中。發展至今已有中上程度的信效度支持，但過去較缺乏臨床上區辨與構念效度的研究，因此本研究旨在探討HPH區辨不同疾患的能力，以及以臨床疾患為受試時量尺之構念效度。 本研究回顧國內外類似測驗─MMPI、KMHQ、MCMI─的發展軌跡，並參照前人作法來進行HPH的臨床區辨效度研究。初步以臨床場域中常見的精神分裂症、重鬱症、低落型情感疾患、焦慮疾患，共257名患者為受試。先以共變數分析(ANCOVA)探討控制人口與臨床變項後，不同疾患組別在HPH的A、B、D類量尺的影響。再進一步使用羅吉斯迴歸(logistic regression)探討哪些量尺及其組合可以區辨兩兩疾患間的差異。最後，本研究也進行HPH的探索性因素分析(exploratory factor analysis)，以檢驗其臨床上的因素結構。 本研究發現，精神分裂症(A1)、躁症傾向(A2)、憂鬱自殺類(A3、B4、A4)、心理功能與健康(D1、D3、D4、D5、D6)量尺在共變數分析上的差異情形與假設大致相符，後續討論分析也支持強迫症(B5)量尺效度。羅吉斯迴歸中，A1、A3、B4、B5能在兩兩疾患間區辨有顯著預測力。其中A1能在精神分裂症與其他三組疾患的兩兩區辨中預測，A3能在重鬱症與另外兩組(精神分裂症、焦慮症)的兩兩區辨中預測，B4能在低落型情感與精神分裂症的兩兩區辨中預測，B5能在強迫症與其他疾患間的兩兩區辨中預測。但是在重鬱症與低落型情感疾患間，以及低落型情感與焦慮疾患間，沒有量尺能在兩者的區辨中有顯著預測力。而各兩兩疾患間整體區辨效果有中至高度的關聯性，分類正確率也多有七成以上，顯示HPH量表在臨床上的區辨效度獲得支持。 構念效度部分，A、D類量尺因素結構與當初編製的每個量尺構念相近，B類量尺構念雖與原量尺略有不同，但仍不違背原量尺編製架構，因此構念效度亦獲得支持。不過各量尺仍有值得編修之處，討論一節中針對結果提出HPH後續編修之建議。 最後，本研究也將此結果之臨床實務應用於討論一節中詳述，以供後續研究與實務者參考。 / The purpose of this study is to examine the clinical validity of the Health, Personality, and Habit Test (HPH). The HPH was developed by Dr. Yung-Ho Ko in 1995, and has been widely used in clinical settings. The HPH has demonstrated appropriate reliability and validity, but little research has been done on its differential and construct validity in the clinical settings. Therefore, the aim of this study is to explore the HPH’s ability to differentiate between disorders and its construct validity in clinical context. This research reviewed the developments of similar tests, such as MMPI, KMHQ, and MCMI, and examined validity of the HPH with the same methods. Subjects were 257 patients who suffered from common disorders in clinical settings, including schizophrenia, major depression, dysthymia, and anxiety disorders. ANCOVA was first used to explore whether different disorders have an effect on category A, B, and D scales after controlling demographic and clinical variables. Next, logistic regression was used to clarify which scales and combinations can differentiate between two of four disorders. Finally, exploratory factor analysis was conducted to examine the structure of HPH in clinical setting. The results of ANCOVA showed that the differences of schizophrenia scale (A1), manic scale (A2), depression/suicide scales (A3, B4, & A4), obsessive-compulsive disorder (OCD) scale (B5), and psychological function and health scales (D1, D3, D4, D5, D6) were partly consistent with assumptions, supporting the differential validity of HPH. The results of logistic regression analysis also supported the validity of A1, A3, B4, and B5 scales. More specifically, A1 was able to differentiate schizophrenia from any other three disorders, A3 was able to differentiate MDD from schizophrenia and anxiety disorders, B4 was able to differentiate dysthymia from schizophrenia, and B5 was able to differentiate OCD from other disorders. However, none of the scales was able to differentiate MDD from dysthymia, nor were they able to differentiate dysthymia from anxiety disorders. Moreover, each of the logistic regression functions showed moderate to high correlations, and most of them achieved high overall hit rates (above 70%), providing support for the clinical differential validity of the HPH. As for construct validity, these factors in category A and D scales were essentially similar to original scales. Similarly, factors in category B scales were compatible to original scales though difference was found. In sum, these results lent support to the construct validity of the HPH in the clinical settings. However, refining of the scales is needed and suggestions are discussed. Finally, the practical uses of the findings were also discussed.