慢性失眠患者病耻感及影响因素研究

Stigma and its influencing factors in patients with chronic insomnia

目的 探究慢性失眠(CID)患者的病耻感及相关影响因素.方法 连续选取2019年9月至2020年6月在安徽某三甲医院睡眠障碍科门诊就诊或住院的72例CID患者作为CID组,选取同时期在本院体检的72名健康人群作为对照组.采用慢性疾病病耻感量表评估其病耻感,采用匹兹堡睡眠质量指数(PSQI)和健康调查简表(SF-36)评估其睡眠质量和生活质量,采用蒙特利尔认知评估量表(MoCA)和汉密尔顿抑郁量表17项版本(HAMD-17)评估其总体认知功能和抑郁状况,比较两组的各量表评分,并分析CID患者病耻感的影响因素.结果 CID组患者的病耻感评分为(38.6±11.7)分,高于对照组的(24.2±0.6)分(t=-6.747,P<0.001);CID组患者的PSQI评分为16.0(15.0,18.0)分,高于对照组的7.0(5.0,8.0)分(Z=-11.687,P<0.001);CID组患者的MoCA评分为(22.3±4.5)分,低于对照组的(25.3±2.1)分(t=5.168,P<0.001);CID组患者的SF-36各成分(生理功能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康)评分均降低(P<0.001).偏相关分析显示,CID组的病耻感与年龄、病程、PSQI评分、HAMD-17评分呈正相关(P<0.001),与文化程度、MoCA评分、SF-36评分呈负相关(P<0.05).多因素回归分析显示,病程和SF-36精神健康域是病耻感的危险因素(P<0.001).结论 CID患者存在病耻感,病程、生活质量、抑郁状况和睡眠质量是其发生的影响因素.

Objective To investigate the stigma of patients with chronic insomnia disorder(CID)and its related influencing factors.Methods From September 2019 to June 2020,a total of 72 patients with CID in the outpatient or inpatient department of sleep disorders in a 3A hospital in Anhui were recruited as the CID group,and 72 healthy subjects who underwent physical examination at the same time in the hospital were selected as the control group.The Chronic Stigma Scale was used to evaluate the stigma of chronic diseases;the Pittsburgh Sleep Quality Index(PSQI)and MOS 36 Short-form Health Survey(SF-36)were used to evaluate sleep quality and the quality of life;the Montreal Cognitive Assessment Scale(MoCA)and 17 items of Hamilton Depression Scale(HAMD-17)were used to evaluate for overall cognitive function and depression.Results The stigma score of CID patients was(38.6±11.7),which was higher than that of the control group(24.2±0.6)(t=-6.747,P<0.001).The PSQI score of CID patients was 16.0(15.0,18.0),which was higher than that of the control group 7.0(5.0,8.0)(Z=-11.687,P<0.001).The MOCA score of CID patients was(22.3±4.5),which was lower than that of the control group(25.3±2.1)(t=5.168,P<0.001).The scores of SF-36 components(Physical functioning,Role-Physical,Body pain,General health,Vitality,Social Functioning,Role-Emotional,Mental Health,Health Changes)of the CID group were all lower than those of the control group(P<0.001).Partial correlation analysis showed that the stigma in the CID group was positively correlated with age,disease course,PSQI score and HAMD-17 score(P<0.001),and negatively correlated with education level,MOCA score and SF-36 score(P<0.05).Multivariate regression analysis showed that the disease course and SF-36 mental health domain were risk factors for stigma(P<0.001).Conclusions Patients with CID have stigma,which is affected by the course of disease,the quality of life,depressed mood and sleep quality.