首诊中老年原发性高血压与发病前2年遭遇生活事件的关系

Association between middle-aged and elderly patients with essential hypertension for the first visit and the encountered life events in the two years before attack

目的:调查首诊中老年原发性高血压患者发病时心理状态与前2年遭遇生活事件的相关性,并与健康组做1∶1配对分析。方法:选择2002-12/2004-12北京市海淀医院收治并确诊的中老年(平均年龄54.3岁)原发性高血压患者95例为观察对象(高血压组),对照组为同期本院进行体检的正常人。两组根据相同年龄、性别、民族、文化程度、婚姻状况1∶1配对。采用症状自评量表作为心理症状调查问卷。采用抑郁自评量表和焦虑自评量表测评抑郁和焦虑症状。患者得分越高,心理症状及焦虑、抑郁情绪越明显。采用生活事件量表调查发病前2年所的遭遇的生活事件,分别计算生活事件频度及强度指标,分值越高,遭遇生活事件越多、频度越大。量表均由受试者填写,测评地点选择在办公室内,全部测试在治疗前完成,对照组在常规体检后进行量表测定。时间为30～40min,量表当场收回。结果:190份问卷均完整合格。①高血压组患者的躯体化、人际关系、抑郁、焦虑、恐怖和偏执等心理症状因子评分明显高于对照组(t=2.134-6.708,P均<0.05)。②高血压组患者中抑郁自评量表标准分≥50分者占35%(33/95),抑郁自评量表标准分均值明显高于对照组犤(46.92±10.75),(42.58±10.36),t=2.833,P<0.05犦。焦虑自评量表标准分≥50分者占65%(62/95),焦虑自评量表标准分均值明显高于对照组犤(51.32±11.04),(40.78±10.57),t=6.721,P<0.05犦。③高血压组遭遇生活事件频度,负性生活事件频度,生活事件强度,负性生活事件强度均明显高于对照组(t=2.647～2.762,P<0.05)。结论:原发性高血压患者发病与发病前2年遭遇的生活事件频度和强度密切相关,同时也与患者存在抑郁、焦虑等心理症状,对事件意义的认知和评价有关。

AIM： To investigate the association between the psychological status at attack and the encountered life events in the two years before attack in middie-aged and elderly patients with primary hypertension for the first visit, and make one-to-one matched analysis with the healthy group. METHODS： Ninety-five middle-aged and elderly patients （the average age was 54.3 years） diagnosed to have primary hypertension patients （hypertension group） for the first visit in the Haidian Hospital of Beijing City between December 2002 and December 2004 participated in the study, and the normal physical examinees （control） in the same hospital at the same period were matched by the same age, gender, nationality, educational level and marriage status at the ratio of 1 to 1. Their psychological symptoms were assessed with symptom checklist-90, and the symptoms of depression and anxiety were evaluated with self-depression scale and self-rating anxiety scale. The higher the scores, the more obvious the psychological symptoms and the emotions of anxiety and depression. Their life events encountered in the last two years were assessed with the life event scale, and the indexes of frequency and intensity of life events were calculated respectively; the higher the scores, the more and the greater frequency of life events they encountered. The scales were completed by the patients in the office before treatment, and those for the subjects in the control group were finished after the routine physical examination, the duration was 30 to 40 minutes, and the scales were collected back on the spot. RESULTS： All the 190 questionnaires were complete and qualified. ① The scores of the psychological factors of somatization, interpersonal sensitivitydepression, anxiety, phobic anxiety and paranoid ideation were obviously higher in the hypertension group than in the control group （t=2.134 to 6.708, P 〈 0.05）. ② In the hypertension group, the standard score of self-rating depression scale was ≥ 50 points in 35% （33/95） of the patients, it was obviously higher than that in the control group [（46.92 ±10.75）, （42.58±10.36）, t=2.833, P 〈 0.05]; the standard score of self-rating anxiety scale was 1〉 50 points in 65% （62/95） of the patients, it was obviously higher than that in the control group [（51.32±11.04）, （40.78 ±10.57）, t=6.721, P 〈 0.05]. ③ The frequency of encountered life events, frequency of negative life events, intensity of life events, and intensity of negative life events were all remarkably higher in the hypertension group than in the control group （t=2.647 to 2.762, P 〈 0.05）. CONCLUSION： The attack of essential hypertension in the patients is closely associated with the frequency and intensity of the life events they encountered in the last 2 years before the attack, it is also correlated with their psychological symptoms of depression and anxiety, and their cognition and evaluation to the significance of the events.