维持性血液透析患者抑郁与自杀意念现状及自杀意念的影响因素

Current status of depression and suicidal ideation in maintenance hemodialysis patients and factors influencing suicidal ideation

目的了解维持性血液透析(MHD)患者抑郁和自杀意念现状及影响因素,为防范血透患者自杀提供依据。方法随机抽取2020年3月至2021年3月在东莞松山湖东华医院进行MHD的106例肾功能衰竭患者,使用患者健康问卷(PHQ-9)和自杀意念自评量表(SIOSS)进行调查。采用多因素logistic回归模型分析MHD患者抑郁与自杀意念现状及自杀意念的影响因素。结果MHD患者抑郁检出率为49%,已经戒烟患者的检出率高于未吸烟和有吸烟患者,小学及以下文化程度的检出率要高于中学或中专、大学及以上文化程度的患者,差异均有统计学意义(P<0.05)。MHD患者自杀意念检出率为19.8%,家庭人均收入<5000元的患者检出率要高于≥5000元的患者,小学及以下文化程度的检出率要高于小学以上文化程度的患者,自费患者检出率要高于医保支付的患者,透析月龄<12个月的患者检出率要高于≥12个月的患者,差异均有统计学意义(P<0.05)。logistic回归模型进行多因素分析结果显示,患者家庭人均收入低(β=1.300,OR=1.273,95%CI=1.182~1.307),透析月龄短(β=0.856,OR=1.425,95%CI=1.185~1.679)是MHD患者自杀意念的危险因素(P<0.05)。结论MHD患者的抑郁情绪和自杀意念存在比较普遍,医务工作者应多维度向患者普及血液透析的相关知识,提高患者对血透的认知,减轻患者抑郁情绪和防范自杀意念的出现。

Objective To understand the status and influencing factors of depression and suicidal ideation in maintenance hemodialysis(MHD)patients,so as to provide basis for preventing suicide in hemodialysis patients.Methods A random sample of 106 kidney failure patients who underwent MHD in Dongguan Songshan Lake Donghua Hospital from March 2020 to March 2021 were investigated by the patient health questionnaire(PHQ-9)and the self-rating idea of suicide scale(SIOSS).Multivariate logistic regression model was used to analyze the status of depression and suicidal ideation and the influencing factors of suicidal ideation in MHD patients.Results The detection rate of depression in MHD patients was 49%.The detection rate of patients who had quit smoking was higher than that of non-smokers and smokers,the detection rate of primary school and below education was higher than that of middle school or specialized secondary school,university and above,the differences were statistically significant(P<0.05).The detection rate of suicidal ideation in MHD patients was 19.8%,and the detection rate of patients with family income of<5000 yuan was higher than that of patients with family income of≥5000 yuan,the detection rate of patients with an education level of primary school and below was higher than that of patients with an education level above primary school,the detection rate of self-paid patients was higher than that of patients paid by medical insurance,the detection rate of patients with dialysis months less than 12 months was higher than that of patients over 12 months,the differences were statistically significant(P<0.05).Multiple factor analysis of logistic regression model showed that the low per capita income of the patients′family(β=1.300,OR=1.273,95%CI=1.182-1.307)and the short age of dialysis months(β=0.856,OR=1.425,95%CI=1.185-1.679)were the risk factors for suicidal ideation in MHD patients(P<0.05).Conclusion The depression and suicidal ideation are common in MHD patients.Medical staffs should popularize hemodialysis related knowledge to patients in multiple dimensions to improve patients′awareness of hemodialysis and reduce depression and prevent suicidal ideation of them.