北京地区老年人抑郁症状筛查检出率及影响因素的横断面调查

Cross-sectional survey on the screening rate of depressive symptoms and related risk factors in the elderly in Beijing

目的通过对北京市社区老年人抑郁症状筛查的检查情况进行流行病学调查,初步了解北京市社区老年人抑郁症状的流行现况,并探讨影响抑郁症状的因素,为早干预提供依据以改善老年人的生活质量,减轻家庭及社会负担。方法2013~2014年,采取分层4阶段抽样的方法选取北京市4个区县3292例社区老年人进行问卷调查和体格检查。采用老年抑郁量表(GDS)和抑郁药物服用情况评估老年人的抑郁症状,其中0~10分者视为正常,11分以上和规律服用抗抑郁药物者为存在抑郁症状。实际完成抑郁量表评估者为3004例。患病率采用2010年全国第六次人口普查北京市标准人口数据进行加权,应用logistic回归模型探讨影响老年人抑郁症状发生的危险因素。结果加权后2963例老年人中,男性占46.2%,平均年龄(73.3±6.1)岁。调查发现229人存在抑郁症状,检出率为7.7%。男性5.7%,女性为9.5%,女性明显高于男性,未见城乡差异,抑郁检出率随年龄增长呈上升趋势。单因素分析结果显示,高龄老人、女性、受教育程度低、没有配偶、独居、伴有慢性疾病(尿失禁、跌倒、心脏病、卒中、视力障碍、失眠等)、无法完成体能检测的老年人抑郁风险增加。非条件logistic回归显示,有视力障碍、女性、失眠、有跌倒史、吸烟和既往脑卒中及无法完成体能检测的老年人抑郁症状检出风险高,OR值分别为4.870(95%CI:2.755~8.610)、1.897(95%CI:1.221~2.947)、1.875(95%CI:1.338~2.627)、1.697(95%CI:1.136~2.534)、1.645(95%CI:1.083~2.497)、1.627(95%CI:1.108~2.389)、1.418(95%CI:1.122~1.793)。结论抑郁症状在社区老年人中检出率较高,尤其是女性、有视力障碍、易跌倒、失眠、有吸烟史或伴有慢性病的老年人,医务工作者特别是社区医生在临床工作中,除了解决患者躯体疾病外也应关注老年人的心理健康问题,及时发现患者存在的抑郁症状,采取心理疏导或药物干预,提高老年人的心理健康水平。

Objective To understand the prevalence of depressive symptoms and to investigate its risk factors in community dwelling older adults. To discuss whether early intervention can help improve the quality of life of the older adults and reduce family and social burden. Methods A stratified multistage random sampling method was conducted to select a sample of 3292 Chinese community dwelling older adults living in four districts in Beijing of China during 2013-2014. Questionnaire survey and physical examination were carried out. The geriatric depression scale(GDS) and antidepressant medications used were used to assess the depressive symptoms,which was completed by 3004 older adults. 0 ~ 10 scores was regard as normal,more than 11 scores and use of antidepressant medication was consider as having depression symptoms. Logistic regression model was applied to explore the risk factors for the occurrence of depressive symptoms in the elderly. Results Overall,229 cases had depressive symptoms in the sample of 2963 older individuals. The prevalence rate of depressive symptoms was 7.7%,and 34.6% in men and 30.8% in women,respectively. The prevalence rate of depressive symptoms was increasing with age. No difference was found between urban and rural areas. The advanced age,female,low level of education,without a spouse,living alone,accompanied by chronic diseases(e.g.,urinary incontinence,falling history,heart disease,stroke,visual impairment,insomnia),failing physical fitness test were the risk factors for symptoms in old adults. Multiple logistic regression analysis showed that visual impairment,female,insomnia,falling history,smoking,stroke history and failing physical fitness test were associated with depressive symptoms,with the odds ratios(95%CI) of 4.870(95%CI:2.755 ~ 8.610),1.897(95%CI:1.221 ~ 2.947),1.875(95%CI:1.338 ~ 2.627),1.697(95%CI:1.136 ~ 2.534),1.645(95%CI:1.083 ~ 2.497),1.627(95%CI:1.108 ~ 2.389),1.418(95%CI:1.122 ~ 1.793),respectively. Conclusion Medical workers,including the community doctors,should pay attention to the mental health problems in the elderly,especially in older female and those who have visual impairment, insomnia, a history of smoking or chronic diseases and et al. Early detection and intervention can improve mental health of the edlderly.