职业病患者心理健康状况及干预效果研究

Study on psychological health status and its intervention effect in occupational disease patients

目的分析职业病患者心理健康状况,探讨应用心理干预措施的效果。方法以整群随机抽样方法抽取本省5家职业病专科医院共526名住院职业病患者为研究对象,在实施心理干预前后采用症状自评量表(SCL-90)、医院焦虑抑郁量表(HAD)进行评定式问卷调查,与国内常模比较,分析职业病患者的心理健康状况和心理干预效果。结果实施心理干预前,职业病患者SCL-90总分(162.34±54.21)高于全国常模(P<0.05),其中,躯体化(1.89±0.78)、焦虑(1.78±0.46)、抑郁(1.92±0.68)、敌对(1.92±0.57)、偏执(1.51±0.87)等5个因子分均高于全国常模(P<0.05或P<0.01);而HAD焦虑维度评分(10.82±2.32)接近阳性(≥11分)水平。实施心理干预后,职业病患者SCL-90总分(135.35±40.32)和躯体化(1.67±0.53)、强迫症状(1.56±0.49)、焦虑(1.51±0.35)、抑郁(1.67±0.62)、敌对(1.59±0.49)、恐怖(1.19±0.54)、偏执(1.38±0.62)、精神病性(1.22±0.39)等8个因子分均较实施前下降(P<0.05);SCL-90总分、总均分、阳性项目数、阳性项目均分与躯体化、焦虑、抑郁等3个因子分仍高于全国常模(P<0.05或P<0.01)。HAD的焦虑(7.38±2.27)、抑郁(3.51±1.86)评分均低于实施前水平(P<0.05),焦虑、抑郁维度阳性率均较实施前下降(P<0.001)。结论职业病患者普遍存在心理卫生问题,职业病治疗过程中给予心理干预措施有助于改善负性情绪和心理障碍,促进患者的治疗和康复。

Objective To analyze the psychological health status of occupational disease patients and to discuss the effect of psychological intervention measure.Methods Five hundred and twenty-six hospitalized patients with occupational diseases were selected using cluster random sampling method from 5 occupational disease hospitals in Guangdong province.Questionnaires with symptoms check list-90（SCL-90） and hospital anxiety and depression scale（HAD） were used before and after psychological intervetion and then the results of SCL-90 were compared with the national norm.Results Before the psychological intervetion,the scores of SCL-90（162.34 ± 54.21） were higher than those of the national norm（P ＆lt; 0.05）,showing higher scores（P ＆lt; 0.05 or P ＆lt; 0.01） of somatization（1.89 ± 0.78）,anxiety（1.78 ± 0.46）,depression（1.92 ± 0.68）,enmity（1.92 ±0.57） and paranoid（1.51 ±0.87）.The HAD anxiety dimension score（10.82 ±2.32） was close to the positive level（≥11）.After the psychological intervetion,the scores of SCL-90（135.35 ± 40.32） and 8 factors including somatization（1.67 ±0.53）,obsessive compulsive disorder（1.56 ± 0.49）,anxiety（1.51 ± 0.35）,depression（1.67 ± 0.62）,enmity（1.59 ±0.49）,terror（1.19 ± 0.54）,paranoid（1.38 ± 0.62） and psychotic（1.22 ± 0.39） of the occupational disease patients were lower than those scores before the implementation of education（P ＆lt; 0.05）.The SCL-90 total score,total average,positive items,positive average score,somatization,anxiety and depression were still higher than those of the national norm（P ＆lt;0.05 or P ＆lt;0.01）.The scores of anxiety（7.38 ±2.27） and depression（3.51 ± 1.86） in HAD were lower than those before the implementation,but the positive rate of anxiety and depression was decreased（P ＆lt; 0.05 or P ＆lt; 0.001）.Conclusion The occupational disease patients commonly suffer from mental health problems and giving psychological intervention measures during treatments could contribute to the improvement of negative emotion and psychological barriers and could promote the treatment and rehabilitation.