阿尔茨海默病患者的家庭照料者心理健康状况及其影响因素分析

Analysis on mental health and its influence factors of family caregivers of patients with Alzheimer′s disease

目的对阿尔茨海默病（AD）患者家庭照料者的心理健康状况及相关因素进行评估。方法采用便利取样方法,选取2013年1-12月符合《国际疾病分类》（ICD-10）诊断标准的64例AD患者及其直系亲属照料者为调查对象,采用症状自评量表90（SCL-90）、Zarit照料负担量表（ZBI）、社会支持评定量表（SSRS）以及简易智力状态检查（MMSE）、日常生活功能量表（ADL）、神经精神科问卷（NPI）分别对照料者和患者进行心理测评,并对有关因素进行调查。结果 ①AD患者家庭照料者的SCL-90总分及躯体化、强迫、人际关系敏感、敌对、恐怖、偏执、精神病性因子评分均显著高于中国常模,差异有统计学意义（P〈0.05或P〈0.01）。②有躯体病、医疗费高的患者、混合型痴呆的家庭照料者SCL-90评分显著高于无躯体病、医疗费低的患者、经典型痴呆的家庭照料者,差异均有高度统计学意义（均P〈0.01）。③家庭照料者SCL-90总分与ZBI总分呈显著正相关（r=0.924,P〈0.01）,与SSRS总分呈负相关（r=-0.288,P〈0.05）,与主观支持得分呈显著负相关（r=-0.355,P〈0.01）。④主要影响因素按偏回归系数由大到小依次为ZBI总分、MMSE总分、痴呆类型、ADL总分、主观支持、躯体疾病（偏回归系数β绝对值=0.831、0.186、0.145、0.108、0.089、0.081）,决定系数R^2=0.892。结论 AD患者家庭照料者的心理健康状况较差,应加强对躯体情况差、主观支持低、患者病情较重的家庭照料者的干预,减轻照料负担,促进心理健康。

Objective To assess mental health and related factors of family caregivers of patients with Alzheimer′ s disease. Methods 64 cases of AD patients with the diagnosis criteria of ICD-10 and their immediate family caregivers were selected as investigation object by convenience sampling method from January to December in 2013, symptom checklist 90（SCL-90）, Zarit burden of care scale（ZBI）, social support rating scale（SSRS）, and the patients were using the mini mental state examination（MMSE）, activity of daily living scale（ADL）, neurology and psychiatry inventory（NPI） were used to evaluate the mental health and influencing factors. Results ① The SCL-90 total scores and the scores of somatization, compulsion, interpersonal sensitivity, hostility, terror, paranoid, psychotic of family caregivers of patients with Alzheimer＇s disease were significantly higher than those of the Chinese norm（P〈0.05 or P〈0.01）.②The SCL-90 scores of family caregivers with somatic disease, high medical expenses and care patients of mixed dementia were significantly higher than those with no disease, low medical expenses and care patients of classic type of dementia（P〈0.01）. ③The total score of SCL-90 of family caregivers were significantly positively correlated with the ZBI total scores（r=0.924, P〈0.01）, and significantly negatively correlated with the SSRS total scores（r=-0.288, P〈0.05）, and significantly negatively correlated with the subjective support score（r=-0.355, P〈0.01）. ④The main influence factors according to the partial regression coefficient from large to small were ZBI total score, MMSE score, the types of dementia, ADL scores, subjective support and the body disease（｜β｜）=0.831, 0.186, 0.145, 0.108, 0.089, 0.081,R^2=0.892. Conclusion Home caregivers of patients with AD have a poor mental health. Therefore, it should be strengthen the intervention to the family caregivers, with poor physical conditions, lower subjective support and sicker patients,to reduce the care burden and promote mental health.