2003—2004年北京地区缺血性卒中后抑郁的患病率及其影响因素

Prevalence and influent factors of post-stroke depression among patients with ischemic stroke living in a community of Beijing

目的调查社区卒中患者卒中后抑郁（poststroke depression,PSD）的患病率及其相关因素。方法在北京市选择约10万人口的自然人群,登记2003年1月—2004年12月该社区所有新发或复发的缺血性卒中患者。采用抑郁自评量表（SDS）评价卒中患者PSD患病情况。共登记380例卒中患者,其中276例符合入选标准并有完整资料,平均年龄（67.5±8.2）岁,卒中病程中位数为11.5个月。结果PSD总患病率为65.2%（180/276）,其中轻、中、重度PSD分别占45.0%、47.2%和7.8%。卒中后6个月内、6～18个月、18个月以上的PSD患病率分别是66.2%、60.2%和73.9%,卒中后6个月内重度PSD患病率最高,达12.3%。PSD患病与左利手、在区县级医院就诊、日常生活依赖、认知功能异常相关,但与年龄、性别、文化程度、婚姻状况、卒中病程、卒中发作次数、高血压或心脏病史无显著相关性。经多因素Logistic回归分析后,显示仅左利手与PSD患病相关。结论60%以上的社区卒中患者患有不同程度的PSD,PSD与在区县级医院就诊、日常生活不能自理、认知功能异常、左利手相关。对于有以上相关因素的卒中患者,对其心理健康状况应给予更多的关注。

Objective To investigate the prevalence of poststroke depression （PSD） and factors influencing PSD in stroke survivors living in a community of Beijing. Methods All of the stroke survivors enrolled in their study were experienced their first stroke or recurrence of stroke from Jan, 2003 to Dec. 2004, and lived for a long time in a community of 100 000 population in Beijing. A total of 274 patients were qualified according to the inclusion criteria, and the PSD was evaluated by self - rating depressive scale （SDS）. The average age of patients was 67.5 ± 8.2 years old,and their median course of stroke was 11.5 months. Results The prevalence of PSD was 65.2%. The proportion of minor, medium and major poststroke depression were 45. 0% ,47. 2%, 7. 8% , respectively. The prevalence of PSD were 66.2% ,60.2% and 73.9%, at 6 months,6 - 18 months and over 18 months after onset of stroke, respectively. The prevalence of major depression was highest （ 12.3% ） in 6 months after onset of stroke, but without statistical difference compared with other time groups. Patients with cognition impairment, dependence of daily living, left handed, and treated of community hospitals in the acute period of stroke had significantly higher prevalence of PSD than the others, and the prevalence had no statistical difference with the patient＇s age, sex, education, marriage status, course of stroke, frequency of stroke, and history of hypertension and heart diseases. According to the multiple logistic regression model analysis, the factor of left handedness had obvious corelation with the occurrence of PSD （OR： 2.47, 95% CI： 1.07 -5.73 ）. Conclusion PSD is occurred in 60% of patients survived from stroke, it is important to take care about their psychological condition after stroke especially for those with cognitive impairment, left handed persons, and dependent of living after stroke.