乳腺癌改良根治术后患者的焦虑、抑郁情绪及生活质量与人格的关系

Correlation of anxiety,depression,quality of life with personality in breast cancer patients after modified radical mastectomy

目的 分析乳腺癌改良根治术后女性患者的心理健康状况,探讨其与患者人格的关系.方法 采用横断面调查研究的方式,纳入2018年9~12月在陆军军医大学第一附属医院乳腺甲状腺外科接受过乳腺癌改良根治术后到门诊或住院部复查的女性患者132例.采用汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表-24(HAMD-24)测定患者的焦虑和抑郁情绪,采用乳腺癌患者生活质量量表(FACT-B)评估患者术后生活质量,用中文版10项目大五人格量表(TIPI-C)评估患者的人格特质.用Spearman相关性分析探讨乳腺癌术后女性患者的HAMA和HAMD-24评分与患者的年龄、术后时间、文化水平的相关性.用Mann-Whitney U检验对比≤50岁组与>50岁组的各个量表评分.生活质量和人格各因素对HAMA、HAMD-24评分的影响采用多重线性回归分析.人格各因素对生活质量的影响也采用多重线性回归分析.结果 患者年龄为(48±9)岁,最大年龄69岁,最小年龄32岁.术后时间为(5±2)个月,范围1~12个月.132例患者中,130例存在焦虑情绪(HAMA评分≥7分),占98.5%,111例存在抑郁情绪(HAMD-24评分≥7分),占84.1%.焦虑情绪与患者的年龄及术后时间呈负相关(r=-0.244、-0.313,P=0.005,P<0.001).≤50岁组与>50岁组患者在HAMA评分、FACT-B的附加关注和TIPI-C的开放性方面差异有统计学意义(Z=-3.142、-2.794、-2.286,P均<0.050).患者术后焦虑情绪的影响因素包括情感状况、生理状况、开放性、神经质性(B=-1.986,95%CI:-3.158^-0.814,t=-3.354,P=0.001;B=-1.765,95%CI:-2.853^-0.678,t=-3.211,P=0.002;B=-0.510,95%CI:-0.796^-0.223,t=3.515,P=0.001;B=-0.425,95%CI:-0.804^-0.046,t=-2.219,P=0.028),而抑郁情绪的影响因素包括情感状况及生理状况(B=-4.123,95%CI:-5.272^-2.974,t=-7.099,P<0.001;B=-2.553,95%CI:-3.762^-1.345,t=-4.179,P<0.001).在人格因素中,外向性、神经质性及尽责性会影响患者的术后生活质量(B=0.469,95%CI:0.350~0.589,t=7.752,P<0.001;B=-0.654,95%CI:-0.823^-0.485,t=-7.671,P<0.001;B=0.545,95%CI:0.364~0.726,t=5.965,P<0.001).结论 乳腺癌改良根治术后女性患者焦虑、抑郁情绪的检出率高.人格因素可能对患者术后的情绪状态及生活质量有影响,临床医师可以根据患者不同的人格特点及术后心理状态选择不同的心理干预手段.

Objective To analyze the mental health of female breast cancer patients after modified radical mastectomy and explore its relationship with personality.Methods In this cross-sectional study,132 female patients who underwent modified radical mastectomy for breast cancer and rechecking in clinic or in-patient units of the Department of Breast and Thyroid Surgery,the First Affiliated Hospital of Army Medical University were enrolled.The Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale-24(HAMD-24)were used to investigate the anxiety and depression of all patients.The Functional Assessment of Cancer Therapy-Breast(FACT-B)was adopted to evaluate postoperative quality of life and the Ten-Item Personality Inventory-Chinese version(TIPI-C)was used to assess the personality of patients.Spearman correlation analysis was used to explore the correlation between the HAMA and HAMD-24 scores of female patients after breast cancer surgery and their age,postoperative time and education.The Mann-Whitney U test was used to compare the scores of four scales between patients≤50 years and patients>50 years.Multiple linear regression analysis was used to investigate the influence of each factor of life quality and personality on HAMA and HAMD-24 scores.The influence of personality factors on quality of life was also analyzed by multiple linear regression.Results The patients were(48±9)years old(range:32-69 years).The postoperative course was(5±2)months(range:1-12 months).Among 132 patients,130 presented anxiety(HAMA score≥7),accounting for 98.5%,and 111 had depression(HAMD-24 score≥7),accounting for 84.1%.Anxiety was negatively correlated with patient age(r=-0.244,P=0.005)and course of disease(r=-0.313,P<0.001).There was a statistically significant difference in the HAMA score,additional attention section of FACT-B and the openness of TIPI-C between patients≤50 years and patients>50 years(Z=-3.142、-2.794、-2.286,all P<0.050).The influencing factors of anxiety in breast cancer patients after surgery included emotional well-being(B=-1.986,95%CI:-3.158--0.814,t=-3.354,P=0.001),physical well-being(B=-1.765,95%CI:-2.853--0.678,t=-3.211,P=0.002),openness(B=-0.510,95%CI:-0.769--0.223,t=3.515,P=0.001),neuroticism(B=-0.425,95%CI:-0.804--0.046,t=-2.219,P=0.028).The influencing factors of depression include emotional well-being(B=-4.123,95%CI:-5.272--2.974,t=-7.099,P<0.001)and physical well-being(B=-2.553,95%CI:-3.762--1.345,t=-4.179,P<0.001).Among the factors of personality,extroversion(B=0.469,95%CI:0.350-0.589,t=7.752,P<0.001),neuroticism(B=-0.654,95%CI:-0.823--0.485,t=-7.671,P<0.001)and conscientiousness(B=0.545,95%CI:0.364-0.726,t=5.965,P<0.001)affected the quality of life after surgery.Conclusions The female breast cancer patients after modified radical mastectomy show a high detection rate of anxiety and depression.Personality traits may have an impact on their postoperative emotional state and quality of life.Clinicians can give psychological intervention according to the patients’personality and postoperative mental state.