住院老年慢性病患者并发焦虑与抑郁的危险因素分析

Analysis on risk factors for anxiety and depression in hospitalized elderly patients with chronic diseases

目的探讨住院老年慢性病患者并发焦虑与抑郁的危险因素。方法连续性收集2015年1月—2017年8月阜阳市人民医院干部老年科收治的200例患者临床资料。利用焦虑自评量表、汉密尔顿抑郁量表和焦虑抑郁认知情况调查表等工具,评价住院老年慢性病患者焦虑与抑郁的发生情况,同时分析可能影响患者心理疾患发生危险因素。结果 200例老年慢性病患者中,109人(54.5%)存在心理异常。其中,抑郁患者97人(48.5%),轻度、中度和重度分别有40例(20.0%)、54例(27.0%)和3例(1.5%)。焦虑患者52人(26.0%),轻度和中度分别有43例(21.5%)和9例(4.5%),无重度焦虑患者。抑郁合并焦虑40人(20.0%)。不同抑郁程度老年患者对抑郁认知的心境、思维、躯体及精神4个纬度,认知评分均存在显著差异,两两比较后发现,中度抑郁组、重度抑郁组的各维度得分无明显差异,但均显著小于轻度组。不同焦虑程度老年患者在焦虑认知的3个纬度,得分无明显差异。与对照组相比,抑郁组患者甘油三酯、总胆固醇、精神质Q评分及神经质N评分显著较高,血清HDL水平、外向E评分明显较低,差异有统计学意义(P<0.05);焦虑组患者甘油三酯、总胆固醇、LDL水平、MPV水平、精神质Q评分、神经质N评分及掩饰程度L评分显著较高,而血糖水平及向外向E评分明显较低,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,影响焦虑发生的主要危险因素依次为神经质N、医疗负担及年龄。影响抑郁发生的主要危险因素依次为医疗负担、年龄及是否独居。结论老年慢性病患者焦虑与抑郁的发生率较高,常与原发病并发存在。医疗负担、年龄及是否独居等是影响发生的主要危险因素,在临床中,有必要对此类进行心理评估,积极干预存在的危险因素,或能进一步提高老年患者的生存质量。

[Objective]To explore the risk factors of anxiety and depression in hospitalized elderly patients with chronic diseases.[Methods] The clinical data of 200 hospitalized patients in Geriatric Department of Fuyang People＇s Hospital from January 2015 to August 2017 were collected.The incidence of anxiety and depression in hospitalized elderly patients with chronic diseases was evaluated by using the self rating anxiety scale,the Hamilton depression scale and the anxiety and depression cognitive questionnaire,and the risk factors of psychological disorders in patients were analyzed. [Results] Among 200 elderly patients with chronic diseases,109 had psychological abnormalities. There were 97（48.5%） depressive patients,including 40（20.0%） mild cases,54（27.0%） moderate cases,and 3（1.5%） severe cases. There were 52 anxiety patients,including 43（21.5%） mild cases and9（4.5%） moderate cases,and no severe case. 40（20.0%） people accompanied with the anxiety and depression. The differences in the cognitive scores of depression in 4 dimensions（mood,thinking,body and spirit） were statistically significant among elderly patients with different degree of depression. There were no statistically significant differences in the scores of 4 dimensions between moderate depression group and severe depression group,while the scores in these two groups were significant lower than those in mild depression group. There were no statistically significant differences in the cognitive scores of anxiety in 3 dimensions among elderly patients with different degree of anxiety. The levels of triglyceride,total cholesterol and the scores of psychoticism Q and neuroticism N in the depression group were higher than those in the control group,while the serum HDL level and extroversion E score were lower than those in the control group,and the differences were statistically significant（P〈0.05）. The levels of triglyceride,total cholesterol,LDL and MPV and the scores of psychoticism Q,neuroticism N and concealment L in the anxiety group were higher than those in the control group,while the blood glucose level and extroversion E score were lower than those in the control group,and the differences were statistically significant（P〈0.05）. The multiple factor logistic regression analysis showed that the main risk factors affecting anxiety were neuroqualitative N,medical burden and age,and the main risk factors affecting depression were medical burden,age,and living alone. [Conclusion] The incidence of anxiety and depression in the elderly patients with chronic diseases is high,and the psychological disorders are often associated with primary disease. The medical burden,age,and living alone are the main risk factors. In clinical practice,it is necessary to carry out psychological assessment for this population,and actively intervene the risk factors,or further improve the quality of life of elderly patients.