儿童期虐待对伴焦虑的抑郁障碍患者临床症状及个性特征的影响

Childhood abuse impact on clinical and personality characters among anxiety associated depressive patients

目的 探讨有儿童期虐待经历伴焦虑的抑郁症患者的临床特点及其个性特征.方法 对36例有儿童期虐待经历伴焦虑症状的抑郁症患者、50例无儿童期虐待经历伴焦虑症状的抑郁症患者分别进行汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、儿童期虐待问卷（CECA-Q）、明尼苏达多相个性调查表（MMPI）调查评定,并将结果加以比较.结果 从HAMD总分来看,有儿童期虐待经历（CA）伴焦虑症状的抑郁症患者均显著高于无CA组（t=7.079,P＜0.05）.从因子分来看,有CA组焦虑躯体化、认知障碍、绝望感因子分与无CA组均差异无统计学意义.从HAMA总分（t=3.108）及精神性焦虑（t=4.037）、躯体性焦虑（t=2.742）来看,有CA组均显著高于无CA组（P＜0.05）.人格倾向比较有CA的患者精神质（P）（t=2.794）、神经质（N）（t=3.217）因子显著高于无CA的患者,差异有统计学意义（P＜0.05）.MMPI因子量表分评定T分除说谎（L）、校正（K）、男女子气（Mf）、轻躁狂症（Ma）外,有CA组均高于无CA组（P＜0.05）,两组MMPI附加因子量表T分比较社会适应（A）、情商（EQ）、决策能力（DE）有CA组均低于无CA组,暴力综合（VL）、交通肇事（DR）、成瘾综合（SA）有CA组高于无CA组（P＜0.05）.儿童期虐待和抑郁的关系上,情感忽视评分与HAMD评分正相关,回归分析显示Y=3.729＋0.887X （P=0.000）;性虐待评分与HAMD评分正相关,回归分析显示Y=9.799＋0.655X （P=0.000）.结论 儿童期有虐待经历的伴焦虑的抑郁症患者临床症状重;个性多为外倾情绪不稳定型,其情商及决策综合能力偏低,暴力倾向明显;情感忽视和性虐待在该病的发病中有重要的作用.

Objective To explore the childhood abuse impact on clinical and personality characters among anxiety associated depressive patients.Methods A case-control method was taken among 86 anxiety associated depression patients,36 cases with childhood abuse and controlled with 50 cases without childhood abuse.HAMD,HAMA,CECA-Q,MMPI were used to evaluate the participants,and the scores of the results were compared between the two groups.Results For the HAND,the group with CA were significantly higher than the group without CA（t=7.079,P＜0.05）.From the point of factor scores,there was not a significant difference between the two groups among the factors such as anxiety somatization,cognitive impairment,and hopelessness.From the point of view of the total scores of HAMA （t=3.108） and spiritual anxiety （t=4.037）,somatic anxiety （t=2.742） the CA group was significantly higher than group without CA（P＜0.05）.In the patients with CA the psychoticism（P） （t=2.794） and neuroticism （N） （t=3.217） factors were significantly higher than patients without CA （P＜0.05）.MMPI evaluation results showed accept ance T points in addition to lie（L）,calibration（K）,male woman（Mf）,light mania（Ma）,the CA group were significantly higher than the group without CA（P＜0.05）.T points to compare two groups of MMPI additional factor scale,the adaptation to the society （A）,emotional intelligence （EQ）,decisionmaking ability （DE）,CA group were lower than the group without CA,violence （VL）,traffic accident （DR） and addiction（SA） with CA group was higher than the group without CA（P＜0.05）.The regression analysis showed that the emotional neglect score and HAMD scores were positively related in the relationship of the childhood abuse and depression.Y =3.729＋0.887 X（P=0.000）.Sexual abuse score and HAND scores were related,regression analysis showed that the Y =9.799 ＋ 0.655 X （P =0.000）.Conclusions The clinical patients with CA have more severe symptoms than the patients without CA.Personality is extraversion more emotionally unstable.Their emotional intelligence and decision-making comprehensive ability is low,and violence tendency is obvious.Emotional neglect and sexual abuse have an important impact in the pathogenesis of the disease.