急性心肌梗死患者急性应激障碍、创伤后应激障碍、焦虑及抑郁的交叉滞后分析

Cross-lagged analysis of acute stress disorder,post-traumatic stress disorder,anxiety and depression in patients with acute myocardial infarction

目的调查急性心肌梗死(AMI)患者急性应激障碍、创伤后应激障碍、焦虑及抑郁的发生情况,并分析患者住院期间的急性应激障碍、焦虑、抑郁对随后1个月时的创伤后应激障碍、焦虑、抑郁的预测效应。方法采用便利抽样法,于2019年9—12月选取哈尔滨市某三级甲等医院457例AMI患者为研究对象,在住院期间(入院1周内)及随后1个月时分别使用急性应激障碍量表(ASDS)、创伤后应激障碍症状问卷中文平民版(PCL-C)、贝克焦虑量表(BAI)以及贝克抑郁量表第2版(BDI-Ⅱ)对其进行调查。结果457例AMI患者住院期间ASD、焦虑、抑郁的发生率分别为31.29%(143/457)、42.23%(193/457)和29.98%(137/457);1个月时AMI患者PTSD、焦虑、抑郁的发生率分别为30.20%(138/457)、10.50%(48/457)和26.48%(121/457)。交叉滞后模型分析结果显示,AMI患者在院期间的急性应激障碍(β=0.11,P<0.05)、焦虑(β=0.16,P<0.01)、抑郁(β=0.25,P<0.01)对1个月时的创伤后应激障碍预测作用均具有统计学意义;住院期间的焦虑、抑郁分别对1个月时的焦虑(β=0.34,P<0.01)和PTSD(β=0.16,P<0.01)、抑郁(β=0.59,P<0.01)和创伤后应激障碍(β=0.25,P<0.01)预测作用均具有统计学意义。多重线性回归分析显示,急性应激障碍的高警觉、再体验与分离症状群对创伤后应激障碍预测效应具有统计学意义(P<0.01)。结论AMI患者住院期间的急性应激障碍、焦虑、抑郁对随后1个月时的创伤后应激障碍、焦虑、抑郁具有正向预测作用,应加强对AMI患者住院期间的心理干预,及时疏解其焦虑、抑郁、恐惧等负性情绪,从而有效降低其后期创伤性应激障碍的发生。

Objective To investigate the acute stress disorder(ASD),post-traumatic stress disorder(PTSD),anxiety,and depression in patients with acute myocardial infarction(AMI),and analyze the predictive effect of ASD,anxiety,and depression during hospitalization on the PTSD,anxiety and depression in the following month.Methods From September to December 2019,convenience sampling was used to select 457 AMI patients from a ClassⅢGrade A hospital in Harbin as the research object.The Acute Stress Disorder Scale(ASDS),Posttraumatic Stress Disorder Checklist-Civilian Version(PCL-C),Beck Anxiety Inventory(BAI)and Beck Depression Inventory-Ⅱ(BDI-Ⅱ)was used to investigate the patients during hospitalization(within one week of admission)and the following month.Results Among 457 AMI patients,the incidence of ASD,anxiety and depression during hospitalization were 31.29%(143/457),42.23%(193/457)and 29.98%(137/457),respectively.The incidence of PTSD,anxiety,and depression in AMI patients at one month was 30.20%(138/457),10.50%(48/457),and 26.48%(121/457),respectively.The results of the cross-lagged analysis showed that ASD(β=0.11,P<0.05),anxiety(β=0.16,P<0.01),depression(β=0.25,P<0.01)during hospitalization had statistical significance in predicting PTSD at one month.Besides,anxiety during hospitalization had statistical significance in predicting anxiety(β=0.34,P<0.01)and PTSD(β=0.16,P<0.01)at one month,and depression during hospitalization had statistical significance in predicting depression(β=0.59,P<0.01)and PTSD(β=0.25,P<0.01)at one month.Multiple linear regression analysis showed that the high alertness,re-experience and separation of symptoms of ASD had statistical significance on the predictive effect of PTSD(P<0.01).Conclusions ASD,anxiety,and depression during hospitalization of AMI patients have a positive predictive effect on PTSD,anxiety,and depression in the following month.Psychological intervention during hospitalization of AMI patients should be strengthened to relieve their anxiety,depression,fear and other negative emotions in time,so as to effectively reduce the occurrence of later traumatic stress disorder.