肾脏疾病患者的心理状况及相关因素

Psychological status and the related factors in patients with kidney disease

目的:了解综合医院不同类型以及疾病不同阶段肾脏病住院患者心理状况,分析其心理障碍的相关因素。方法:调查于2004-03/04在第三军医大学附属新桥医院肾内科及泌尿外科完成。84例不同肾脏疾病患者为男49例,女35例,年龄18～76岁,病程0.3～360个月,接受肾透析者19例,接受肾移植者11例,其他为一般肾脏病患者。应用90项症状清单、艾森克个性测验-成人、生活事件量表、疾病影响程度量表,及自制一般情况调查表进行调查。调查由专人负责分组进行,严格按量表评定方法及标准进行评定,采用上海惠诚心理测试软件分析,对发现心理症状的患者进一步面谈交流了解其心理状况。结果:共调查84例肾脏疾病患者均进入结果分析。①90项症状自评量表调查结果:肾脏疾病患者躯体化症状、强迫、抑郁、焦虑、敌对、精神疾病因子明显高于常模组犤(1.80,1.37),(1.86,1.62),(1.85,1.50),(1.75,1.39),(1.81,1.48),(1.57,1.29)犦。②不同肾脏疾病精神状况比较结果:免疫代谢患者抑郁精神状况筛检阳性率最高为80.0%,炎性疾病的患者最易出现强迫症状和驱体化症状,发生率均为45.5%,肾衰竭易出现躯体化和敌对症状,发生率均为45.0%。③肾脏疾病心理障碍相关因素分析:肾脏疾病患者的心理障碍大都与人格精神质、神经质、负性生活事件、婚姻、工作、人际关系及疾病本身对患者造成的躯体或社会功能损失显著相关。不同精神障碍与不同的因素有关,躯体化障碍与家庭、工作、环境、上网等因素显著相关,焦虑受学习、家庭、环境、对子女的满意度的影响。结论:肾脏疾病患者存在躯体化障碍、焦虑、抑郁、恐惧、强迫、敌对和精神病性症状等多种心理障碍;心理障碍在不同类型、阶段肾脏疾病中的分布仅抑郁症状有差异。个性、生活事件、躯体状况、环境、社会地位等多种因素与患者的心理障碍有关。

AIM： To investigate the psychological status of inpatients with kidney disease of different types and at different phases in comprehensive hospital, and analyze the factors related to their psychological disorders. METHODS：The investigation was completed in the Department of Nephrology and Department of Urinary Surgery, Xinqiao Hospital affiliated to the Third Military Medical University of Chinese PLA between March and April 2004. Totally 84 patients （49 males and 35 females） with different kidney disease aged 18-76 years, whose disease course was 0.3-360 months, participated in the study, including 19 cases received renal dialysis, 11 cases received renal transplantation, others were patients with common kidney disease. They were surveyed with symptom checklist-90 （SCL-90）, Eysenck personality questionnaire-aduh version （EPQ）, life event scale （LES）, disease influence degree scale and self-design general information inventory. The survey was performed in groups by specia] personnels strictly referred to the methods and standard of the scale evaluation. The results were analyzed with Shanghai Huicheng psychological test software. The patients with psychological symptoms were face-to-face communicated to investigate their psychological status. RESULTS： All the 84 patients with kidney disease were involved in the analysis of results,①Results of SCL-90： The scores of somatizatin, compulsion-obsession, depression, anxiety, hostility, and psychoticism were obviously higher in the patients with kidney disease than in norms [（1.80, 1.37）,（1.86, 1.62）, （1.85, 1.50）, （1.75, 1.39）, （1.81, 1.48）, （1.57, 1.29）].②Mental status in patients with different kidney disease： The positive rate of depression was the highest in patients with immune metabolism （80.0%）. The symptoms of compulsion-obsession and somatization occurred the easiest in patients with inflammatory disease （45.5%）, the incidence rates were both 45.0%.③ The analysis of factors related to psychological disorders in patients with kidney disease： Most psychological disorders in patients with kidney disease were significantly correlated with the personalities of psychoticism and neuroticism, negative life events, marriage, work, interpersonal sensitivity, somatic or social functional loss caused by the disease itself. Different mental disorders were correlated with different factors： somatization disorder had significant correlation with family, work, environment and networking, and anxiety was affected by learning, family, environment, and satisfactory degree to children. CONCLUSION： Patients with kidney disease have different mental disorders of somatization disorder, anxiety, depression, phobic anxiety, compulsion-obsession, hostility and psychoticism. Only the distribution of depressive symptom in the psychological disorders has difference among patients with kidney disease of different types and at different phases. The psychological disorders are associated with various factors of personality, life events, somatic status, environment and social status.