上海市2012年社区在册糖尿病和高血压患者抑郁、焦虑阳性率及其影响因素

Positive rate and associated factors of anxiety and depressive symptoms among community-dwelling hypertension and diabetes patients

目的了解社区在册糖尿病、高血压患者抑郁和焦虑症状阳性率及其影响因素,为后期干预提供依据。方法 2012年8月—2013年2月从上海2个区所辖3家社区卫生服务中心在册的2型糖尿病和高血压患者中随机抽样,采用患者健康问卷(PHQ–9)和广泛性焦虑自评量表(GAD–7)评估患者的抑郁和焦虑症状,并探讨其影响因素。结果共调查糖尿病、高血压患者8 813例,抑郁症状(PHQ–9≥5分)和焦虑症状(GAD–7≥5分)阳性率分别为14.7%和7.0%,抑郁或焦虑症状任一阳性的比例为16.0%;其中糖尿病合并高血压患者的阳性率最高(抑郁19.7%,焦虑9.4%,抑郁或焦虑21.3%),其次是仅有糖尿病的患者(抑郁16.3%,焦虑7.4%,抑郁或焦虑17.7%),仅有高血压患者最低(抑郁12.3%,焦虑5.9%,抑郁或焦虑13.4%);多因素回归分析显示,受教育水平低、离婚/丧偶、并发症多、半年内综合性医院就诊次数多、以及糖尿病合并高血压患者的抑郁或焦虑阳性率更高。结论社区糖尿病和高血压患者中抑郁和焦虑症状较为常见,应该在社区卫生服务中逐步纳入相应问题的筛查和干预,以改善该人群的健康水平。

Objective To examine the positive rate and influential factors of anxiety and depressive symptoms among community patients with hypertension or diabetes and to provide evidences for future interventions. Methods Patients with type-2 diabetes or hypertension registered in 3 community health service centers in 2 districts of Shanghai were recruited with cluster random sampling for a self-administered questionnaire survey during the period from August 2012 to February 2013. We identified participants with depressive or anxiety symptoms using Patient Health Questionnaire-9 （PHQ-9） and Generalized Anxiety Disorder Scale-7 （GAD-7） and explored the factors related to these symptoms. Results A total of 8 813 diabetes or hypertension patients completed the survey. The proportion of patients with depressive symptoms （score of PHQ-9 ≥ 5） and anxiety symptoms （score of GAD-7 ≥ 5） were 14.7% and 7%, respectively, and 16.0% of the patients had either depressive or anxiety symptoms. The positive rates were the highest among the patients with both diabetes and hypertension （19.7% for depression, 9.4% for anxiety, and 21.3% for depression or anxiety）, followed by those among the patients with only hypertension （16.3% for depression, 7.4%, for anxiety, and 17.7% for depression or anxiety）; and the positive rates were lowest among the patients with only diabetes （12.3% for depression, 5.9% for anxiety, and 13.4% for depression or anxiety）. Multivariate regression analyses indicated that depressive or anxiety symptoms were more prevalent in patients with lower education, divorced or widowed, with more complications, having more general hospital visits within previous six months, and with comorbided diabetes and hypertension. Conclusion Depressive and anxiety symptoms are common in community-dwelling patients with hypertension or diabetes. Screening and intervention on these symptoms should be gradually incorporated into community health services to improve the health status of the patients.