抑郁症共病其他精神障碍的特点及相关因素

Characteristics and related factors of comorbidity among patients with depression disorder

目的:了解一般人群中抑郁症患者共病其他精神障碍的情况和特点及相关因素。方法:以河北省精神疾病流行病学抽样调查中诊断的现患抑郁症399例为研究对象,以美国精神障碍诊断与统计手册第四版轴Ⅰ障碍定式临床检查患者版(Structured Clinical Interview for DSM-Ⅳ AxisI Disorders-Patient Edition SCID-I/P)为诊断工具。采用大体功能量表(Global Assessment of Function,GAF)、匹茨堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)中国修订版评估患者的严重程度和睡眠质量。结果:399例抑郁症患者与其他精神障碍的共病率为48.4%,其中37.1%共病1种精神障碍,11.3%共病2种精神障碍。共病焦虑障碍占35.6%,共病未特定的焦虑障碍20.05%,共病心境恶劣障碍14.04%,共病创伤后应激障碍5.26%,共病广泛焦虑症4.26%,共病惊恐障碍3.01%。共病组患者精神运动性激越、自杀观念和行为等症状出现的频率明显高于非共病组(62.69%vs.48.06%,45.08%vs.35.44%,7.77%vs.1.94%,Ps<0.05)。Lo-gistic回归分析显示信仰宗教是共病心境恶劣障碍的保护性因素,60～69岁是共病未特定焦虑障碍的危险因素,20～29岁、60～69岁、低收入、独居是共病惊恐障碍的危险因素,40～59岁是共病创伤后应激障碍高风险年龄,已婚是保护性因素。结论:抑郁症共病其他精神障碍的现象比较常见,其中共病心境恶劣障碍和未特定焦虑障碍较多见,共病不同精神障碍的危险因素和保护性因素不同。

Objective： To understand the situation and characteristics of comorbidity in patients with depression disorder. Methods： Totally 399 patients who were suffering from depression through the epidemiological survey of mental illness in Hebei Province were taken as the research objects. The Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition （SCID-I/P） was used as a diagnostic tool. The depression severity of patients was assessed with the Global Assessment of Function （ GAF） . Meanwhile the sleep quality of the patients was assessed with the Pittsburgh Sleep Quality Index （ PSQI ） . Results： Among all the investigated depression patients, 48.4% comorbided with other mental disorders, 37.1% comorbided with one kind of other mental disorder, and 11.3% comorbided with two kinds of other mental disorder. Among all disorders comorbiding with depression, 35.6% were anxiety disorders, 20.05% were unspecified anxiety disorders, 14. 04 % were dysthymic disorder, 5.26% were post-traumatic stress disorder, 4. 26% were generalized anxiety disorder, and 3.01% were panic disorder. The major depressive symptoms had no difference between comorbidity group and the non-comorbidity group, but psychomotor agitation, suicidal ideas and behavior of the comorbidity group were significantly higher than those without comorbidity （ 62. 69% vs. 48. 06%, 45.08% vs. 35.44%, 7.77% vs. 1.94%, Ps 〈 0. 05 ） . Logistic analysis showed that religion could reduce the occurrence of dysthymic disorder, and being 60 -69 could be risky factor for unspecified anxiety disorders. For panic disorder, being 20 - 29 or 60 - 69 years of age, low income, and living alone were risky factors. For post-traumatic stress disorder, being 40 - 59 years of age was a negative factor, while marriage might be a positive factor. Conclusion： In this study, 48.4% of patients with depression comorbid other mental disorders, and 35.6% comorbid with anxiety disorders. Dysthymic disorder and unspecified anxiety disorders are common in depression comorbidity. Factors affecting comorbidity are different.