脑出血出院患者及其主要照顾者抑郁状况

Depression status of discharged patients with cerebral hemorrhage and their main caregivers

目的分析脑出血患者出院后与其主要照顾者的抑郁状况,探讨影响患者与主要照顾者抑郁的相关因素。方法应用横断面研究方法,在脑出血患者发病后12个月时对其本人及主要照顾者进行问卷调查。分析脑出血患者与主要照顾者的抑郁状况。将2019-01—2020-03郑州市第九人民医院治疗并幸存的脑出血患者214例及其主要照顾者214人全部纳为研究对象。根据多因素Logistic回归模型的样本量需求,设计样本量为200以上。实际共发放问卷223份,回收问卷221份,问卷回收率98.66%。再剔除其中资料欠详的7份。最终纳入研究样本214份。问卷资料主要包括3部分:(1)一般资料:在查阅文献及参考专家意见的基础上,由研究者自行设计;(2)抑郁:应用抑郁自评量表(SDS)进行评测;(3)日常生活能力:应用日常生活能力量表(ADL)进行评测。结果(1)脑出血患者在发病12个月后抑郁发病率30.37%。单因素分析结果:2组(抑郁和未抑郁)患者的年龄、教育年限、SDS和ADL评分有统计学差异(P<0.05)。多因素分析结果:患者年龄大、患者教育年限多、患者存在明显日常生活能力障碍是脑出血患者发病12个月后抑郁的危险因素(P<0.05)。(2)脑出血患者发病12个月后主要照顾者抑郁发病率12.62%。单因素分析结果:2组(抑郁和未抑郁)照顾者的教育年限、家庭照顾者人数、是否与患者居住、与患者关系、SDS和ADL评分有统计学差异(P<0.05)。多因素分析结果:患者教育年限多、主要照顾者教育年限多、家庭照顾者人数多是脑出血患者发病12个月后主要照顾者抑郁的保护因素(P<0.05);与患者关系是夫妻、患者存在明显日常生活能力障碍是脑出血患者发病12个月后主要照顾者抑郁的危险因素(P<0.05)。结论基于护理人员的支持不仅是对卒中幸存者还是护理患者的家庭成员,应探讨更加便捷、安全、有效的护理模式,如通过电话或门诊为患者及其主要照顾者提供心理支持,培养多学科合作的脑出血合作团队,促进患者及其主要照顾者的心理康复。

Objective To analyze the depression status of patients with cerebral hemorrhage and their main caregivers after discharge,and to explore the related factors affecting the depression of patients and their main caregivers.Methods Cross-sectional study was used.12 months after the onset of cerebral hemorrhage,a questionnaire survey was conducted among the patients and their main caregivers.To analyze the depression of patients with cerebral hemorrhage and their main caregivers.From January 2019 to March 2020,214 patients with intracerebral hemorrhage treated and survived in our hospital and 214 of their main caregivers were included in the study.According to the sample size demand of multivariate logistic regression model,the design sample size is more than 200.A total of 223 questionnaires were distributed and 221 questionnaires were recovered,with a questionnaire recovery rate of 98.66%.Seven copies of which are not detailed shall be excluded.214 samples were finally included in the study.The questionnaire mainly includes three parts:(1)general information,which is designed by the researcher on the basis of consulting literature and expert opinions;(2)Depression was assessed by SDS;(3)The ADL was used to evaluate the ability of daily living.Results(1)The incidence of depression in patients with cerebral hemorrhage 12 months after onset was 30.37%.Results of univariate analysis:there were significant differences in age,years of education,SDS and ADL scores between the two groups(depressed and non depressed)(P<0.05).Results of multivariate analysis:the risk factors of depression 12 months after the onset of intracerebral hemorrhage were older patients,more years of education and obvious impairment of activities of daily living(P<0.05).(2)12 months after the onset of intracerebral hemorrhage,the main caregivers’depression incidence rate was 12.62%.Results of univariate analysis:there were significant differences between the two groups(depressed and non depressed)in the number of years of education,family caregivers,whether they lived with patients,relationship with patients、SDS and ADL scores(P<0.05).Results of multivariate analysis:the protective factors of depression in the main caregivers of patients with intracerebral hemorrhage 12 months after the onset of intracerebral hemorrhage were the number of years of education of patients,the number of years of education of main caregivers and the number of family caregivers(P<0.05);The relationship with the patients was that the husband and wife and the patients had obvious ADL disorder,which were the risk factors of depression in the main caregivers of patients with intracerebral hemorrhage 12 months after the onset of intracerebral hemorrhage(P<0.05).Conclusion Caregiver-based support is not only for stroke survivors but also for caring family members of the patient;more convenient,safe,and effective care models should be explored,such as providing psychological support to patients and their primary caregivers via telephone or outpatient clinics,and cultivating multidisciplinary cooperation in cerebral hemorrhage cooperation team,and promoting the psychological recovery of patients and their primary caregivers.