老年慢性疼痛病人初诊时焦虑抑郁状况及其影响因素分析

ANXIETY AND DEPRESSION IN ELDERLY PATIENTS WITH CHRONIC PAIN AT INITIAL DIAGNOSIS AND RELATED INFLUENCING FACTORS

目的探讨老年慢性疼痛病人初诊时焦虑抑郁状况,并对相关影响因素进行分析,为相关干预措施的制定提供参考。方法采用一般资料调查表、视觉模拟评分法(VAS)、焦虑自评量表及抑郁自评量表对2017年1—8月于我院疼痛科住院的219例病人进行调查分析。结果 219例病人中抑郁者65例(29.7%),焦虑者78例(35.6%),同时患有焦虑和抑郁者48例(21.9%),病人焦虑和抑郁状态呈正相关关系(r=0.51,P<0.05)。多因素Logistic回归分析显示,年龄70～79和≥80岁者(OR=0.51,95%CI=0.16～0.92,P<0.05,OR=0.58,95%CI=0.13～0.75,P<0.05)、已婚者(OR=0.59,95%CI=0.13～0.81,P<0.05)、最近1个月未发生睡眠障者(OR=0.42,95%CI=0.09～0.91,P<0.05)较少出现抑郁状态,而BMI>28kg/m2者(OR=1.43,95%CI=1.03～2.83,P<0.05)、VAS>7分者(OR=3.40,95%CI=1.06～9.57,P<0.05)、疼痛史1～3和>3年者(OR=3.73,95%CI=1.24～11.99,P<0.05;OR=3.29,95%CI=1.06～12.47,P<0.05)更容易出现抑郁状态。已婚者(OR=0.78,95%CI=0.13～0.91,P<0.05)、最近1个月未发生睡眠障者(OR=0.24,95%CI=0.03～0.84,P<0.05)较少出现焦虑状态,而VAS>7分者(OR=2.30,95%CI=1.06～6.57,P<0.05)、疼痛分组为复杂性疼痛者(OR=2.41,95%CI=1.31～7.51,P<0.05)、疼痛史1～3和>3年者(OR=2.73,95%CI=1.24～5.99,P<0.05,OR=2.29,95%CI=1.06～6.47,P<0.05)更容易出现焦虑状态。结论老年慢性疼痛病人易伴发焦虑、抑郁症状,医师在临床诊疗时需关注这些易导致焦虑、抑郁的因素,治疗慢性疼痛的同时应对病人予以心理或药物干预,以更好控制疼痛。

Objective To investigate anxiety and depression in elderly patients with chronic pain at initial diagnosis and related influencing factors,and to provide a reference for developing related intervention measures.Methods A total of 219 patients who were hospitalized in Department of Pain Management in our hospital from January to August,2017 were enrolled,and a general information questionnaire,Visual Analogue Scale(VAS),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used for investigation and analysis.Results Among the 219 patients,65(29.7%)had depression,78(35.6%)had anxiety,and 48(21.9%)had both depression and anxiety;anxiety was positively correlated with depression in these patients(r=0.51,P<0.05).The multivariate logistic regression analysis showed that the patients with an age of 70-79,and≥80 years(OR=0.51,95%CI=0.16-0.92,P<0.05;OR=0.58,95%CI=0.13-0.75,P<0.05),who were married(OR=0.59,95%CI=0.13-0.81,P<0.05),or who did not experience sleep disorder within the past one month(OR=0.42,95%CI=0.09-0.91,P<0.05)had a lower risk of depression,while the patients with a body mass index of>28 kg/m 2(OR=1.43,95%CI=1.03-2.83,P<0.05),a VAS score of>7(OR=3.40,95%CI=1.06-9.57,P<0.05),or a duration of pain of 1-3,and>3 year(OR=3.73,95%CI=1.24-11.99,P<0.05;OR=3.29,95%CI=1.06-12.47,P<0.05)were more likely to suffer from depression.The patients who were married(OR=0.78,95%CI=0.13-0.91,P<0.05)or who did not experience sleep disorder within the past one month(OR=0.24,95%CI=0.03-0.84,P<0.05)had a lower risk of anxiety,while the patients with a VAS score of>7(OR=2.30,95%CI=1.06-6.57,P<0.05),complex pain(OR=2.41,95%CI=1.31-7.51,P<0.05),or a duration of pain of 1-3,and>3 year(OR=2.73,95%CI=1.24-5.99,P<0.05;OR=2.29,95%CI=1.06-6.47,P<0.05)were more likely to suffer from anxiety.Conclusion Elderly patients with chronic pain tend to develop depression and anxiety.Physicians should pay attention to the factors which may lead to anxiety and depression in clinical diagnosis and treatment,and psychological or pharmaceutical interventions should be given during the treatment of chronic pain,so as to control the pain better.