突发性耳聋患者的心理障碍及相关因素分析

Psychiatric Disorders in Sudden Deafness Patients and Associated Factors

目的探讨突发性耳聋患者的精神心理特点及相关因素分析。方法用症状自评量表(self-reportinginventory 90,SCL-90)对1000例突发性耳聋患者的精神心理状态评分,然后与中国常模行对照研究。采用视觉模拟量表(visual analogue scale,VAS)对与突发性耳聋相关的耳鸣、眩晕、失眠、耳堵塞感和精力下降5项主观症状进行评分,将其评分和心理学评分行相关性分析。对突聋患者作组内比较,分析不同性别、年龄、病程、文化程度与精神心理障碍的关系。以SPSS 19.0软件对数据进行统计学分析。结果突聋患者心理有轻度损害者716名(71.6%),中度损害者102名(10.2%)。患者的抑郁(t=4.10,P=0.01)、人际关系敏感(t=4.46,P=0.00)、躯体化(t=4.21,P=0.00)、焦虑(t=3.03,P=0.02)和其他(睡眠、饮食,t=4.65,P=0.00)共5项因子高于中国常模。对5项主观症状的评分和心理学评分行相关性分析发现,耳鸣、耳堵塞感与人际关系敏感呈正相关趋势,失眠、耳堵塞感、精力下降与抑郁呈正相关趋势,耳鸣、失眠、精力下降与焦虑呈正相关趋势,眩晕、失眠、耳堵塞感与其他(睡眠、饮食)呈正相关趋势。突聋组SCL-90组内比较显示:女性的人际关系敏感(Z=-3.09,P=0.00)、抑郁(Z=-2.30,P=0.02)、焦虑(Z=-2.11,P=0.04)、其他(睡眠、饮食,Z=-2.82,P=0.01)评分高于男性;年龄更小者的敌对(Z=-2.27,P=0.01)和恐怖(Z=-2.08,P=0.04)评分更高;病程更长者的人际关系敏感(Z=-2.12,P=0.02)和焦虑(Z=-3.01,P=0.01)评分更高;学历更低者的偏执(Z=-2.25,P=0.02)评分更高。结论突发性耳聋患者有轻度和中度的心理健康损害;人际关系敏感、抑郁、焦虑和其他(睡眠、饮食)随病情的加重而严重;女性、年龄更小者、病程更长者、学历更低者是相对的高危人群。

Objective To report psychiatric disorders and associated factors in sudden deafness patients.Methods Psychological evaluation was performed in 1,000 sudden deafness patients using the SCL-90 questionnaire.The results were compared with healthy controls.A visual analogue scale(VAS)was used to evaluate five subjective symptoms,i.e.tinnitus,vertigo,insomnia,ear blockage and energy level decline,which was then correlated with the psychological scores.In sudden deafness patients,the relationship among gender,age,course of disease,culture and mental health disorders was analyzed by the SCL-90.Results Mild or moderate levels of psychosis were noted in 71.6%and 10.2%of sudden deafness patients,respectively,with high scores for depression(t=4.10,P=0.01),interpersonal sensitivity(t=4.46,P=0.00),somatization(t=4.21,P=0.00),anxiety(t=3.03,P=0.02)and other(sleep and diet,t=4.65,P=0.00)as compared with healthy controls.Correlation analysis showed that interpersonal sensitivity,depression,anxiety and other(sleep and diet)had a significant impact on the disease.SCL-90 indicated higher scores for interpersonal sensitivity(Z=-3.09,P=0.00),depression(Z=-2.30,P=0.02),anxiety(Z=-2.11,P=0.04)and other(sleep,diet,Z=-2.82,P=0.01)in women than in men.The scores for hostility(Z=-2.27,P=0.01),paranoia(Z=-2.25,P=0.02)and photic anxiety(Z=-2.08,P=0.04)in junior patients were higher than in senior patients.The scores for interpersonal sensitivity(Z=-2.12,P=0.02)and anxiety(Z=-3.01,P=0.01)were higher for long disease course than for short disease course.Conclusions Psychiatric disorders are prevalent in sudden deafness patients,especially in the forms of interpersonal sensitivity,depression,anxiety and sleep and diet disorders.Female gender,junior age,long disease course and low education level are risk factors.