慢性乙型肝炎患者的临床心理因素分析及应对策略

Clinical psychological factors and treatment strategies for patients with chronic hepatitis B

目的探讨慢性乙型肝炎患者临床心理的人格、应对、社会支持方面与抑郁、焦虑症状的相关关系及治疗对策。方法对66例慢性乙型肝炎患者(乙肝组)和72例正常人(对照组)进行问卷调查,采用人口学病史资料问卷、艾森克人格问卷(EPQ)、特质应对方式问卷(TCSQ)、领悟社会支持量表(PSSS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMD)进行评定。结果乙肝组HAMD评分、HAMA评分高于对照组(P<0.05)。Pearson相关分析结果显示,抑郁症状与积极应对、家庭外支持、内外向呈负相关,与精神质、神经质呈正相关,焦虑症状与积极应对、家庭内支持、家庭外支持、内外向呈负相关,与神经质呈正相关。多元线性逐步回归分析结果显示,家庭外支持、积极应对、神经质、精神病性4个自变量(β=0.002、0.003、0.004、0.022)进入回归方程,且可预测抑郁症状;神经质、积极应对2个自变量(β=0.003,0.011)进入回归方程,且可预测焦虑症状。结论慢性乙型肝炎患者比正常人更易患抑郁、焦虑,其中抑郁症状与患者人格中的精神质、神经质密切相关,焦虑症状与神经质有关,神经质的个性特征、缺乏积极应对策略及家庭外支持可能导致抑郁、焦虑发生。改善患者个性特征,积极应对,完善家庭外的社会支持体系,有助于减少乙型肝炎患者抑郁、焦虑症状发生,从心理-社会学层面提供了新的治疗策略。

Objective To analyze the correlation between clinical mental personality, cop- ing style, social support and depression, anxiety for patients with chronic hepatitis B, and their treatment strategies. Methods A total of 66 patients with chronic hepatitis B （ CHB group） and 72 normal people （control group） were investigated by the questionnaire, such as the demographic history questionnaire, Eysenck Personality Questionnaire （EPQ）, Trait Coping Style Questionnaire （TCSQ）, Perceived Social Support Scale （PSSS）, Hamilton Depression Scale （HAMD）, Hamilton Anxiety Scale （HAMD） were assessed. Results The HAMD score and HAMA score of hepatitis B group were significantly higher than that of the control group. Pearson correlation analysis showed that depressive symptoms was negatively correlated with positive coping, family support, extroversion, and was positively correlated with neuroticism. Multiple linear regression analysis showed family support, active coping, neuroticism and psychosis were all included in the regression equation and can predict depressive symptoms（ β values, 0.002, 0. 003,0.004, 0.022, respectively）. Neuroticism, positive responded to the two independent variables （β values, 0.003, 0.011, respectively） into the regres- sion equation, and can predict anxiety symptoms. Conclusion The patients with chronic hepatitis B were more prone to suffer from depression and anxiety than normal people, depressive symptoms are closely related to the neuroticism and neuroticism. The anxiety symptoms are related to neuroticism. The neurotic personality traits, lack of positive coping strategies and out-of-home support may lead to depression and anxiety. Depression and anxiety symptoms can be avoided by improving the patient＇s personality characteristics, and actively responding and enhancing the social support system outside the home seas to reduce depression, anxiety symptoms in patients with hepatitis B.