风湿免疫病住院患者的抑郁与自杀风险分析

Analysis of Depression and Suicide Risk in Hospitalized Patients with Rheumatic Immune Diseases

目的调查评估风湿免疫科住院患者心理状况,进行抑郁与自杀风险评估分析,早期识别抑郁状态及自杀高危患者,针对性护理干预,保障住院患者安全。方法纳入2018年10月至2019年9月温州医科大学附属第一医院风湿免疫科住院治疗患者作为研究对象,入院时采用健康问卷抑郁症状群量表(PHQ-9)调查,进行简易心理状态初筛,评估患者的抑郁状态及自杀风险。结果共收集861例患者资料,分析发现风湿免疫病住院患者心境障碍检出率24.62%,中度以上抑郁7.43%,有自杀风险比例3.72%;系统性红斑狼疮、强直性脊柱炎、干燥综合症、类风湿关节炎、痛风这五种常见风湿免疫病PHQ-9评分有自杀风险的人群比例为2.56%,中度以上抑郁比例为3.13%;不同疾病患者抑郁的发病率明显不同(χ^(2)=27.734,P<0.001),经Fish精确检验分析,提示不同疾病患者表现中度及以上抑郁者的比例有显著统计学差异(χ^(2)=13.187,P<0.05)。其中系统性红斑狼疮患者抑郁发病率显著高于其他类疾病患者,且中度以上抑郁和自杀风险比例也较其他疾病高。结论风湿免疫性疾病住院患者抑郁状态和自杀风险检出率高,且抑郁发病率与PHQ-9评分呈正相关,不同风湿免疫病引起患者抑郁的发病率有显著差异;护理人员入院时运用PHQ-9评分行简易心理状态初筛,有助于分级分类落实护理路径干预,或可降低患者自杀发生率,减少医疗纠纷。

Objective To investigate the mental status of the patients in rheumatic immunology department,and evaluate the risk of depression and suicide,so as to identify the patients with depression and high risk of suicide,ensure the safety of the patients.Methods Patients in the Department of Rheumatology of the First Affiliated Hospital of the Wenzhou Medical University from October 2018 to September 2019 were included in the study.All the patients were investigated with the health questionnaire depression symptom cluster scale(PHQ-9)at the time of admission,the depression status and suicide risk were assessed.Results Data of 861 patients were collected.The prevalence of mood disorder,moderate depression and suicide risk were 24.62%,7.43%and 3.72%respectively.The rate of suicide risk was 2.56%in patients with systemic lupus erythematosus(SLE),ankylosing spondylitis(AS),sjogren’s syndrome(SS),rheumatoid arthritis(RA)and metabolic arthritis(MA),and the rate of moderate to severe depression was 3.13%.The incidence of depression in patients with different diseases was significantly different(χ^(2)=27.734,P<0.0001).Fish analysis showed that there was significant difference in the proportion of patients with moderate depression or above(χ^(2)=13.187,P<0.05).The prevalence of depression was significantly higher in SLE patients than in the other four groups,and the rates of moderate to severe depression and suicide were also higher than in the other groups.Conclusions The prevalence of depression and suicide risk is high in patients with rheumatic diseases,and the incidence of depression is positively correlated with the PHQ-9score.The application of simple mental state screening by PHQ-9 score bank on admission of nursing staff is helpful to carry out nursing path intervention by grading and classification,might reduce the incidence of patient suicide and medical disputes.