住院冠心病患者1083例心理状况的调查与相关分析

Psychological status in 1083 hospitalized patients with coronary artery disease

目的 探讨住院冠心病患者焦虑和抑郁症状的发生情况及相关因素.方法 采用现况调查研究,自2007年6月至2009年5月连续入选经冠状动脉造影诊断的住院冠心病患者.选用Zung焦虑自评量表（SAS）和抑郁自评量表（SDS）对入选患者进行心理测评,同时对受试者的经济状况、家庭情况、生活及工作场所环境等因素进行流行病学调查.统计学处理采用Student＇s t检验、卡方检验和多元逐步logistic回归分析.结果 共入选住院冠心病患者1083例,年龄（64.8±10.2）岁,其中男性863例,女性220例.单纯焦虑、单纯抑郁、焦虑合并抑郁的症状患病率分别为7.9%、28.3%和14.3%.女性患者焦虑、抑郁的症状患病率明显高于男性（29.5%比20.3%,P=0.003;50.0%比40.7%,P=0.012）;老年（≥65岁）患者焦虑症状的患病率明显高于非老年患者（25.9%比17.9%,P=0.001）;老年人、受教育年限少于9年、睡眠质量差与焦虑症状的发生显著相关,相应OR值分别为1.63（95%CI：1.21～2.21,P=0.002）、1.54（95%CI：1.15～2.07,P=0.004）和1.62（95%CI：1.34～1.96,P=0.000）;长期工作地噪音、合并慢性疾病及睡眠质量差与抑郁症状的发生显著相关,OR值分别为1.52（95%CI：1.18～1.98,P=0.002）、1.36（95%CI：1.06～1.75,P=0.016）和1.27（95%CI：1.08～1.50,P=0.005）;女性、老年人、长期工作地噪音、合并慢性疾病、睡眠质量差与焦虑合并抑郁症状的发生显著相关,OR值分别为1.91（95%CI：1.22～2.98,P=0.005）、1. 84（95%CI：1.23～2.76,P=0.003）、1.61（95%CI：1.07～2.42,P=0.022）、1.84（95%CI：1.24～2.71,P=0.002）和1.73（95%CI：1.35～2.21,P=0.000）.结论 在住院冠心病患者中,约50%患者并发不同程度的焦虑和（或）抑郁症状,女性和老年患者是高发人群.受教育年限少于9年、合并慢性疾病、睡眠质量差、工作地噪音等与焦虑、抑郁症状的发生相关.

Objective To explore the prevalence and associated factors of anxiety and depression symptoms in hospitalized Chinese patients with coronary artery disease（CAD）. Methods From June 2007 to May 2009, 1083 hospitalized patients with confirmed coronary artery disease were recruited in this study.The ZUNG Self-rating Anxiety Scale（SAS）and the ZUNG Self-rating Depression Scale（SDS）were used for the psychological assessment. Economic status, living condition and the environment of both living and working places were evaluated by epidemiological questionnaires. Results The prevalence of pure anxiety,pure depression symptoms and the combination of anxiety and depression symptoms were 7. 9%, 28.3% and 14. 3% respectively. Incidence of anxiety and depression symptoms was significantly higher in female patients compared with in male patients（P = 0. 003, 0. 012 respectively）and in aged patients than in middle-aged patients（P = 0. 001）. The elderly, less than 9 years of education and poor sleep quality increased the risk of anxiety symptom with ORs of 1.63（95% CI： 1. 21 - 2. 21）, 1.54（95% CI： 1.15 -2. 07）and 1.62（95% CI： 1.34 - 1.96）, respectively, while workplace noise, history of chronic disease and poor sleep quality increased the risk of depression symptom with ORs of 1.52（95% CI：1. 18 - 1.98）,1.36（95%CI：1.06-1.75）and 1.27（95%CI：1.08-1.50）, respectively. Female（OR=1.91, 95%CI：1. 22 -2.98）, aged patient（OR = 1.84, 95% CI：1. 23 -2. 76）, workplace noise（OR = 1.61, 95%CI：1. 07 -2. 42）, history of chronic disease（OR = 1.84, 95% CI： 1.24 - 2. 71）and poor sleep quality （OR = 1.73, 95% CI： 1.35 -2. 21）were significantly correlated with the combined incidence of anxiety and depression symptoms. Conclusion Around half of the Chinese hospitalized CAD patients were complicated with various degrees of anxiety and/or depression symptoms. Female and aged patients were at higher risk for anxiety and depression symptoms. Sleep quality, workplace noise, years of education and history of chronic disease were independent risk factors for anxiety or depression symptoms.