妇科恶性肿瘤患者自杀意念现状及影响因素研究

The Current Situation and Influencing Factors of Suicidal Ideation in Patients with Gynecological Malignancies

目的探讨妇科恶性肿瘤患者自杀意念现状及其影响因素,为自杀的危机干预提供依据。方法选取2012年9月—2013年6月中南大学湘雅三医院、中南大学湘雅医院、中南大学湘雅二医院及湖南省肿瘤医院4所三级甲等医院住院的697例妇科恶性肿瘤患者,应用自制一般资料问卷、中文版医学应对方式问卷(MCMQ)、社会支持评定量表(SSRS)、自杀意念自评量表(SIOSS)进行调查,并对自杀意念的影响因素进行单因素分析和多因素Logistic回归分析。结果妇科恶性肿瘤患者自杀意念总分为(7.21±4.58)分,发生率为18.4%(128/697)。不同疾病诊断患者自杀意念发生率间差异有统计学意义(χ2=17.556,P<0.001),其中卵巢癌患者自杀意念发生率(30.3%,44/145)高于宫颈癌患者(15.3%,74/483)、子宫内膜癌患者(14.5%,10/69),差异有统计学意义(P<0.05)。Logistic回归分析显示,确诊时间〔OR=1.258,95%CI(1.060,1.492)〕、屈服得分〔OR=1.550,95%CI(1.411,1.703)〕和社会支持总分〔OR=0.953,95%CI(0.915,0.991)〕最终进入回归模型(P<0.05)。结论卵巢癌患者自杀意念发生率高,影响妇科恶性肿瘤患者自杀意念的因素有确诊时间、屈服得分及社会支持总分。医务人员应重视患者的心理状况,及时识别自杀高危人群,提高患者的社会支持水平,鼓励其采用积极的应对方式,从而减少自杀行为的发生。

Objective To investigate the prevalence of suicidal ideation and its influencing factors in patients with gynecological malignancies so as to provide evidence for crisis intervention on suicide. Methods 697 patients with gynecological malignancies were surveyed with self- designed questionnaire of General Information about patients with gynecological malignancies, Medical Coping Modes Questionnaire （MCMQ）, Social Support Rating Scale （SSRS） and Suicidal Ideation of Self- rating Scale （SIOSS） . Univariate and multivariate logistic regression analyses were used to identify the influencing factors of suicidal ideation. Results Mean score and prevalence of suicidal ideation were （7. 21 ± 4. 58 ） and 18.4% （ 128/697 ） in patients with gynecological malignancies. The prevalence between patients diagnosed with various diseases was significantly different （ X2 = 17. 556, P 〈 0. 001 ） ： the prevalence of suicidal ideation was highest in patients with ovarian cancer （ 30. 3%, 44/145 ）, which was significantly higher than that in patients with cervical cancer （ 15.3% , 74/483 ） and endometrial cancer （ 14. 5% , 10/69） （P 〈 0.05） . Logistic regression analysis showed that the influencing factors in patients with gynecological malignancies included diagnosis time [ OR = 1. 258, 95% CI （ 1. 060, 1. 492 ） ], resignation score [ OR = 1,550, 95% CI （ 1. 411, 1. 703 ） ] and total social support score （ OR =0. 953, 95% CI （0. 915, 0. 991 ） 3 . Conclusion The suicidal ideation was high in patients with ovarian cancer. Diagnosis time, resignation, social support are the fluencing factors. Medical staff should pay more attention to patients＇ psychological status and identify those patients who are at high suicide risk. We should also be aimed at improving patients＇ social support and encouraging patients to use positive copying strategies so as to reduce suicide.