病耻感与首发卒中患者卒中后抑郁的相关性研究

Correlation between Stigma and Post-stroke Depression in Initally Diagnosed Stroke Patients

背景心理-社会因素是卒中后抑郁(PSD)重要的发病机制之一,病耻感给患者带来的认知、情绪和行为的改变可能与PSD的发生密切相关,却很少被重视。目的探讨病耻感与首发卒中患者PSD的相关性。方法采用横断面调查研究设计和便利抽样的方法,选取2019年7—12月就诊于南方医科大学南方医院、广东三九脑科医院神经内科和神经外科的首发卒中患者299例。记录患者人口学资料和卒中病史资料。使用卒中病耻感量表(SSS)、9条目患者健康量表(PHQ-9)、改良Rankin量表(mRS)评估患者卒中后1个月时病耻感、抑郁和神经功能恢复情况。结果共纳入299例首发卒中患者,完整随访221例,脱落78例。根据PHQ-9评分分组,PSD组65例(29.4%,PHQ-9评分≥5分),非PSD组156例(70.6%,PHQ-9评分为0~4分)。PSD组SSS总分及躯体障碍、社会交往、受歧视经历、自我感受、PHQ-9、mRS评分均高于非PSD组(P<0.05)。相关性分析结果显示,PHQ-9评分与SSS总分及躯体障碍、社会交往、受歧视经历、自我感受、mRS评分呈正相关(r_s=0.606、0.319、0.441、0.369、0.616、0.389,P<0.05)。多因素Logistic回归分析结果显示,SSS总分是首发卒中患者发生PSD的影响因素〔OR=1.263,95%CI(1.158,1.379),P<0.05〕。结论首发卒中患者早期的病耻感对PSD具有一定的预测价值,医护人员和患者家属应采取相应措施,警惕PSD的发生。

Background Psychosocial and scoial factors are important participators in the pathogenesis of poststroke depression(PSD).However,the fact that cognitive,emotional and behavioral changes brought by stigma may be closely related to PSD has received little attention.Objective To explore the correlation between stigma and PSD in initally diagnosed stroke patients.Methods In this cross-sectional study,by use of convenience sampling,initially diagnosed stroke patients(n=299)were recruited from Neurology and Neurosurgery Departments of Nanfang Hospital,Southern Medical University and Guangdong 999 Brain Hospital from July to December 2019.Socio-demograpchics and stroke-related history were collected.The stigma,depression and severity of disability at the end of 1-month follow-up were evaluated using the Stroke Stigma Scale(SSS),Patient Health Questionnaire-9(PHQ-9)and modified Rankin Scale(mRS),respectively.Results 78 cases were excluded due to loss to follow-up,other 221 cases who completed the follow-up were included for final analysis.By PHQ-9 score,65(29.4%)and 156(70.6%)were evaluated with and without PSD,respectively.PSD patients experienced higher score of physical impairment,social isolation,discrimination experience,internalized stigma,and scores of SSS,PHQ-9,and mRS than non-PSD patients(P<0.05).Correlation analysis revealed that PHQ-9 score was positively correlated with score of SSS,physical impairment,social isolation,discrimination experience,internalized stigma,and mRS,respectively(r_s=0.606,0.319,0.441,0.369,0.616,0.389,P<0.05).Multivariate Logistic regression analysis illustrated that score of SSS was an independent associated factor of PSD in initally diagnosed stroke patients〔OR=1.263,95%CI(1.158,1.379),P<0.05〕.Conclusion Stigma manifested in the early stage of stroke may be used as a predictor of PSD in initally diagnosed stroke patients.So medical workers and family members of the stroke patient should be on fully alert for PSD.