山东省抑郁障碍患者应对方式特点及影响因素研究

The characteristics and influencing factors of coping style in patients with depression in Shandong province

目的探讨山东省抑郁障碍患者应对方式的特点及影响因素。方法研究组为2015年山东省精神障碍流行病学调查中诊断出的且量表完整的1174例抑郁障碍患者,对照组为按照与研究组同性别、同年龄组、同村居1∶1配对原则,自调查对象中抽取的筛查阴性者。研究工具包括自制的一般资料调查表、一般健康问卷(GHQ-12)及增加的风险评估问题、DSM-Ⅳ轴Ⅰ障碍用临床定式检查(SCID-I/P)、功能大体评定量表(GAF)及简易应对方式问卷(SCSQ)。结果研究组SCSQ积极应对评分低于对照组,消极应对评分高于对照组(P<0.01)。未特定抑郁障碍的积极应对评分高于其他两个亚型(P<0.01)。研究组中不同职业、医疗来源、年龄、受教育程度、GAF评分的积极应对评分比较差异有统计学意义(P<0.05),研究组中仅不同居住方式的消极应对评分比较差异存在统计学意义(P<0.01)。相关性分析结果显示,受教育程度、GAF评分与积极应对评分均呈正相关(P<0.01),年龄与积极应对评分呈负相关(P<0.01)。回归分析结果显示,医保/商业保险、受教育程度、GAF评分能预测积极应对评分的4.8%。结论抑郁障碍患者较一般人群多采取消极应对方式,较少采取积极应对方式;恶劣心境障碍患者采取积极应对方式的能力更差;无医疗来源、较低的受教育程度、严重的社会功能受损是抑郁障碍患者积极应对能力的危险因素。

Objective To explore the characteristics and influencing factors of coping style in patients with depression in Shandong province.Methods A total of 1174 patients diagnosed with depressive disorder in 2015 Shandong Epidemiological Survey of Mental Disorders with complete scale in study group,and 1174 screened negative subjects who were 1∶1 matched with study group in gender,age group and community in control group were selected and assessed with self-designed general information questionnaire,General Health Questionnaire(GHQ-12)and additional risk assessment questions,Structured Clinical Interview for DSM-IV(SCID-I/P),Global Assessment Function(GAF)and Simplified Coping Style Questionnaire(SCSQ).Results The positive coping style score in study group was significantly lower than that in control group,while the negative coping style score was significantly higher than that in control group(P<0.01).The positive coping style score in patients with unspecific depressive disorder was significantly higher than those in patients with dysthymia and major depressive disorder(P<0.01).In study group,there existed significant differences in positive coping style scores among patients with different professions,patterns of payment,ages,educational levels and GAF scores(P<0.05),and significant difference in negative coping style scores among patients with different living styles(P<0.01).Correlation analysis showed that educational level and GAF score were positively correlated with positive coping style score(P<0.01),and age was negatively correlated with positive coping style score(P<0.01).Stepwise regression analysis showed that health insurance/commercial insurance,educational level and GAF score could predict 4.8%of positive coping style scores.Conclusion Compared with healthy controls,patients with depression tend to adopt more negative coping styles and less positive coping styles.Patients with dysthymia are less able to adopt positive coping styles.Lack of access to health care,low educational level,and severe impairment of social function are risk factors for positive coping ability in patients with depression.