养老机构老年人抑郁情绪发展轨迹及预测因素分析

Trajectory of depression among institutionalized elderly persons and its determinants

目的探讨养老机构老年人抑郁的异质性发展轨迹类型,并分析日常生活活动能力(ADL)对抑郁发展轨迹的预测作用。方法采用纵向研究设计,对符合条件的296名养老机构老年人采用Barthel指数评定表、患者健康问卷-2(PHQ-2)、社会网络量表对ADL、抑郁和社会支持进行调查,并在6个月、12个月随访抑郁发生情况。结果养老机构老年人抑郁患病率基线调查为14.9%(44/296),第1次随访为20.9%(51/244),第2次随访为17.2%(36/209);以完成2次调查的250人为样本拟合出2条老年人抑郁的异质性轨迹,即高风险(14.8%)和低风险(85.2%);年龄、既往职业、ADL得分影响其抑郁发展轨迹(P<0.05,P<0.01)。结论养老机构老年人抑郁存在异质性轨迹,ADL低者抑郁呈恶化趋势。应关注机构老年人日常生活能力的锻炼,减少抑郁的发生。

Objective To investigate the heterogeneous trajectories of depression among institutionalized elderly persons and to identify the predictive effect of activities of daily living(ADL).Methods A longitudinal study was conducted on 296 institutionalized elderly persons,using the Barthel Index(BI),Patient Health Questionnaire-2(PHQ-2)and Lubben Social Network Scale(LSNS)to collect their ADL level,depression and social support,at baseline assessment.Then they were followed up 6 and 12 months later and measured for depression intensity.Results The prevalence of depression among the subjects was 14.9%at baseline assessment,20.9%at 6-month follow-up and 17.2%at 12-month follow-up.Two different depression trajectories were identified in 250 subjects who completed two assessments:high-risk deterioration(14.8%)and low-risk deterioration(maintenance,85.2%).Age,occupation,and ADL score were predictors of depression trajectory(P<0.05,P<0.01).Conclusion Institutionalized elderly persons showed distinct trajectories of depression,and low ADL level might deteriorate their depression.It is necessary to strengthen ADL training for institutionalized elderly persons,thus to reduce the incidence of depression.