支气管哮喘儿童社交障碍的影响因素

Influencing Factors of Social Disorder in Children with Bronchial Asthma

目的：探讨支气管哮喘儿童社交障碍的影响因素,为患儿心理健康教育提供依据。方法：收集2014年3月-2015年3月来我院就诊的哮喘患儿380例,采用DSM-IV轴I障碍用临床定式检查（SCID-I/P）联合儿童社交焦虑量表（SASC）评分对380名哮喘儿童进行一对一问诊,确诊存在社交障碍的患儿94例设置为观察组,其余社交正常患儿为对照组（286例）,对比分析两组患者的病史资料,对其应用儿童抑郁障碍自评量表（DSRSC）、Spence儿童焦虑量表（SCAS）、儿童孤独症评定量表（CARS）进行评分,采用单因素方差分析和多元回归分析支气管哮喘儿童社交障碍的相关影响因素。结果：支气管哮喘儿童社交障碍检出率为24.7%,其中男58例,女36例,不同性别哮喘儿童社交障碍检出率比较无明显差异（χ^2=0.072,P=0.788）;单因素方差分析发现,观察组与对照组在生长地、家庭结构、家庭经济水平、母亲受教育程度、父母对哮喘的认识态度、阳性精神疾病家族史、发作时病情严重程度、病程、DSRSC、SCAS、CARS评分等11个方面均存在明显差异（χ^2=7.851,13.715,4.253,13.109,18.887,4.656,4.095,8.481,16.228,18.750,13.099;P〈0.05）;经多元回归分析发现患儿母亲受教育程度和父母对哮喘的认识态度对患儿社交障碍的影响最显著（Waldχ^2=-12.01,10.42;P〈0.05）,家庭经济水平影响最小（Waldχ^2=3.42,P=0.021）,余下影响因素从大到小分别为DSRSC评分、SCAS评分、CARS评分、家庭结构（单亲家庭）、病程〉2年、发作时病情严重程度（重-极重度）、生长地（农村）（Waldχ^2=9.17,8.95,8.86,8.73,7.16,6.23,6.11;P〈0.05）。结论：影响患儿社交障碍的主要因素有母亲受教育程度较低,父母对哮喘的认识态度不正确,存在抑郁、焦虑、孤独的人格特质,家庭结构为单亲家庭,哮喘病程较长,哮喘发作时病情较重,生长地在农村以及家庭经济水平较差,对于这部分患儿,我们应该提高警惕,及时对患儿及其家属进行心理干预。

Objective：To explore the influencing factors of social disorder in children with bronchial asthma and to provide evidence for children＇s mental health education.Methods：A total of 380 cases of asthma children treated in our hospital from March 2014 to March 2015 were collected for the study and interviewed or inquired one by one by means of the DSM-IV axis I disorders with clinical interview examination（SCID-I/P）combined with the children＇s social anxiety scale（SASC）score.94 cases of children diagnosed with social disorder were selected as the observation group,and the rest of children（286 cases）with normal social connection were enrolled in the control group.The medical records were compared and analyzed between the two groups,and the patients were scored and assessed by the children＇s self-rating depression scale（DSRSC）,the Spence children＇s Anxiety Scale（SCAS）and the children autism rating scale（CARS）.Single factor analysis of variance and multiple regression were used to analyze the related factors of social disorder in children with bronchial asthma.Results：The detection rate of social disorder in bronchial asthma children was 24.7%,including 58 males（25.2%）and 36 females（24.0%）.And there was no significant difference in the detection rate of social disorder among children with different sexes.The single factor variance analysis showed that there were significant differences in the 11 aspects between the observation group and the control group,such as growth area,family structure,family economic status,mother＇s education,parents＇ attitudes towards asthma,family history of positive mental illness,the severity and duration of disease onset,DSRSC,SCAS and CARS scores and so on（χ^2=7.851,13.715,4.253,13.109,18.887,4.656,4.095,8.481,16.228,18.750,13.099;P〈0.05）.Multivariate regression analysis found that mother＇s education and parents attitude towards asthma had the most significant impact on children with social disorder（Waldχ^2=-12.01,10.42,P〈0.05）,and the family economic level had the minimum impact（Waldχ^2=3.42,P〈0.05）.The remaining factors from high to low were DSRSC score,SCAS score,CARS score,family structure（single parent family）,duration of disease2 years,the severity of disease onset（from heavy to severe）,the growth area（rural area）（Waldχ^2=9.17,8.95,8.86,8.73,7.16,6.23,6.11;P〈0.05）.Conclusion：The main factors influencing the social disorder of children are the lower education level of the mother,incorrect parents＇ attitude towards asthma,personality traits with depression,anxiety and loneliness,single parent family structure,longer asthma course,heavier asthma attack,growing in rural areas and poor family economic level.For this part of the children,we should be vigilant and timely to give psychological intervention for children and their families.