胸痛患者焦虑和抑郁发生情况及其影响因素研究

Prevalence and Associated Factors of Anxiety and Depression in Patients Admitted for Chest Pain

背景胸痛患者是焦虑、抑郁的高发人群,但胸痛患者中焦虑、抑郁与冠状动脉病变、胸痛病因的相关性尚不十分明确。目的探讨胸痛患者焦虑、抑郁发生情况及其影响因素。方法连续性选择2016年12月—2017年10月上海交通大学附属第六人民医院以胸痛为主诉且收入心内科诊治的310例患者作为胸痛组,胸痛组患者又分为冠心病亚组和非冠心病亚组,无焦虑和抑郁亚组和有焦虑和/或抑郁亚组;同时选择年龄、性别匹配,无胸闷、胸痛等不适主诉的48例健康体检者作为对照组。详细询问胸痛组患者的病史,记录胸痛特征,采用广泛性焦虑症状量表-7(GAD-7)评估焦虑状况,采用9条目患者健康问卷(PHQ-9)评估患者抑郁状况,采用自行设计的一般情况调查表调查患者一般资料。比较胸痛组和对照组、非冠心病亚组和冠心病亚组焦虑、抑郁发生率,及无焦虑和抑郁亚组与有焦虑和/或抑郁亚组患者胸痛特征、冠状动脉狭窄程度、胸痛病因的差异。采用多因素Logistic回归分析分析胸痛患者焦虑、抑郁的影响因素。结果胸痛组焦虑、抑郁、焦虑合并抑郁的发生率高于对照组(P<0.05)。非冠心病亚组焦虑、抑郁及焦虑合并抑郁的发生率高于冠心病亚组(P<0.05)。无焦虑和抑郁亚组与有焦虑和/或抑郁亚组患者胸痛病程、发作时间、活动相关气促、合并多种症状、服扩血管药物0.5 h内好转情况比较,差异有统计学意义(P<0.05);两亚组冠状动脉狭窄程度、胸痛病因比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,与焦虑相关的危险因素有生活压力大、社会支持少,有吸烟史有利于减少焦虑(P<0.05);与抑郁相关的危险因素有胸痛病程长、合并多种症状、失眠(P<0.05)。结论胸痛患者焦虑、抑郁发生率高,生活压力大、社会支持少、胸痛病程长、合并多种症状、失眠的患者需警惕合并焦虑、抑郁的可能。

BackgroundChest pain patients are high-risk population for anxiety and depression,but the associations of anxiety and depression with coronary artery disease（CHD） and causes of chest pain have not been fully investigated.ObjectiveWe carried out this study in order to evaluate the prevalence and associated factors of anxiety and depression in inpatients admitted for chest pain.MethodsWe enrolled 358 participants from Shanghai Jiaotong University Affiliated Sixth People＇s Hospital from December 2016 to October 2017,including 310 consecutive patients admitted to Cardiovascular Department for chest pain（chest pain group） and 48 age- and sex-matched healthy physical examinees without self-reported chest tightness and chest pain（control group）.We collected the data concerning medical history,features of chest pain,and general characteristics（estimated by a self-developed General Questionnaire） of the chest pain patients.Generalized Anxiety Disorder 7（GAD-7） was used to evaluate anxiety,and Patient Health Questionnaire-9（PHQ-9） was applied to evaluate depression in both groups.Comparisons were performed between chest pain patients and controls,between chest pain patients with CHD and those without in terms of the prevalence of anxiety and /or depression,and between chest pain patients with anxiety and/or depression and those without regarding the features of chest pain,coronary stenosis and causes of chest pain.Multivariate Logistic regression analysis was used to determine the associated factors of anxiety and depression in chest pain patients.ResultsCompared with the controls,chest pain patients were found with higher prevalence of anxiety, prevalence of depression and prevalence of anxiety and depression（P〈0.05）.Chest pain patients with CHD showed lower prevalence of anxiety, prevalence of depression and prevalence of anxiety and depression than those without（P〈0.05）.The duration of suffering from chest pain,the time of onset of chest pain,shortness of breath during activity,prevalence of multiple physical symptoms,the proportion of turned better by taking vasodilator drugs within 0.5 hours differed significantly between chest pain patients with anxiety and / or depression and those without（P〈0.05）.Multivariate Logistic regression analysis revealed that in chest pain patients,severely stressful life experience and insufficient social support were risk factors while smoking was a protective factor for anxiety（P〈0.05）,prolonged duration of suffering from chest pain,multiple physical symptoms and insomnia were risk factors for depression（P〈0.05）.ConclusionPatients admitted for chest pain are at high risk of anxiety and depression.Those with at least one of the risk factors（severely stressful life experience,insufficient social support,prolonged duration,coexistence of multiple physical symptoms,insomnia） may possibly have anxiety and/or depression.