大城市综合医院冠心病病人抑郁/焦虑影响因素探讨

Study on risk factors of depressive and/or anxiety symptoms in patients with coronary heart disease in general hospitals of urban China

目的探讨中国大城市冠心病患者发生抑郁和，或焦虑症状的危险因素。方法采用现况研究方法．于2004年6月1日到12月1日在北京、上海、广州和成都的7家综合性医院的心内科连续收集确诊的冠心病患者359例。由经培训的调查员用统一的调查表进行面对面调查，同时使用综合医院焦虑抑郁量表（HAD）进行心理测评。对数据进行多元无序多分类Logistic回归分析。结果359名对象中HAD9分或以上者82名（22．8％）。生活不能完全自理影响罹患单纯抑郁症状，OR=17．996（95％CI：3．872～83．636）；非老年人、受教育年限不超过9年、主观感觉病情加重影响罹患单纯焦虑症状，相应OR分别为3．151（95％CI：1．151～8．629）、3．154（95％CI：1．094～9．092）和4．229（95％CI：1．396～12．809）；住院和生活不能完全自理影响罹患抑郁合并焦虑症状，OR分别为4．887（95％CI：1．711～13．960）和6．583（95％CI：2．776～15．612）。结论中国大城市综合医院冠心病病人的抑郁症状和，或焦虑可能与生活不能完全自理、非老年人、受教育年限不超过9年、主观感觉病情加重和住院有关，这些病人的抑郁焦虑问题应该在临床诊疗和健康促进过程中得到更多关注。

Objective To explore the risk factors of depressive and/or anxiety symptoms in patients with coronary heart disease （CHD） in the general hospital of main cities in China. Methods A hospital-based cross-sectional study was conducted in four main cities in China in 2004. 359 CHD patients were recruited continually during six months from the outpatient and inpatient department of 7 tertiary hospitals. Face-to-face inters＇Jew was used in data collection together with the serf-completed HAD scale for depressive and/or anxiety symptom screening. Multinomial Logistic Model was adopted in data analysis. Results Among 359 CHD patients. 82 （22.8%） obtained a HAD score of 9 and above. Non-ambulatory patients had a statistically higher risk of depressive symptoms （ OR = 17. 996, 95 % CI：3. 872 - 83. 636） ; subjects younger than 65 years old, or having an education year equal or less than 9 year, or having a self-assessment of CHI） deterioration had increased risk of anxiety symptoms with the ORs at 3. 151 （95% CI： 1. 151-8.629）, 3,154（95% CI： 1.094-9.092） and 4.229 （95% CI： 1,396-12.809） respectively. Hospitalized （OR = 4.887, 95% CI： 1.711-13.960） and non- ambulatory （OR = 6.583, 95% CI： 2.776-15.612） CHD patients were more liable to suffer both depressive and anxiety symptoms. Conclusion It was noticeable to health care providers both in somatic disease care and mental health care that non-ambulatory status, younger than 65 years old, lower education level, felt deterioration of CHD and hospitalization were possible risk factors for depressive and/or anxiety symptoms in patients with CHD in general hospitals in urban China.