急性脑梗死患者抑郁和孤独在创伤后应激障碍与失能中的中介效应

Mesomeric effect of depression and loneliness on post-traumatic stress disorder and disability in patients with acute cerebral infarction

目的探讨急性脑梗死患者情感障碍(抑郁和孤独)在创伤后应激障碍(PTSD)与失能中的内在联系。方法选取2020年1月至2022年12月在徐州市第一人民医院就诊的320例急性脑梗死患者进行横断面研究,其中男273例、女47例,年龄46~85(64.8±15.9)岁。采用问卷调查方式对患者进行资料采集,包括一般资料、世界卫生组织失能评定量表(WHO-DAS 2.0)、创伤后应激障碍自评量表(PTSD-SS)、抑郁自评量表(SDS)、加州大学洛杉矶分校孤独量表(UCLA)。统计学方法采用t检验、χ^(2)检验,Spearman相关性分析和Bootstrap法验证抑郁、孤独在创伤后应激效应与失能间的中介效应。结果急性脑梗死患者WHO-DAS2.0总分为(98.62±32.25)分,PTSD-SS总分为(83.15±24.01)分,SDS总分为(62.46±23.52)分,UCLA总分为(48.59±19.27)分。抑郁、孤独、PTSD与失能两两相关(均P<0.05)。中介效应模型显示,抑郁、孤独与失能之间有间接效应,效应值分别为0.196、0.110,效果量分别为14.75%、20.48%,PTSD-孤独-抑郁-失能的链式中介效应值为0.061,效果量为46.37%;PTSD与失能的效应值为0.079,证实PTSD与失能没有直接联系。结论急性脑梗死患者具有PTSD心理状态,但PTSD并未直接对失能造成影响,能以完全中介效应途径通过抑郁和孤独对失能施加影响,可提高患者生活质量。

Objective To explore the mesomeric effect of affective disorders(depression and loneliness)on post-traumatic stress disorder(PTSD)and disability in patients with acute cerebral infarction.Methods Three hundred and twenty patients with acute cerebral infarction who were treated in Department of General Medicine,Xuzhou First People's Hospital between January 2020 and December 2022 were selected for the cross sectional study,including 273 males and 47 females.They were 46-85(64.8±15.9)years old.The data were collected from the patients using questionnaires,including general information,World Health Organization Disability Assessment Scale(WHO DAS 2.0),Post-Traumatic Stress Disorder Self-rating Scale(PTSD-SS),Self-rating Depression Scale(SDS),and University of California Los Angeles Loneliness Scale(UCLA).t andχ^(2) tests were applied.Results The scores of WHO-DAS 2.0,PTSD-SS,SDS,and UCLA were(98.62±32.25),(83.15±24.01),(62.46±23.52),and(48.59±19.27)in the patients.Depression,loneliness,PTSD,and disability were correlated each other(all P<0.05).The mediation model validation showed indirect effects of depression and loneliness on disability,with effect values of 0.196 and 0.110 and effect sizes of 14.75%and 20.48%.There was a chain mediation effect of the PTSD-loneliness-depression-disability,with the effect value of 0.061 and the effect size of 46.37%.PTSD did not show any significant direct effect on disability,with an effect value of PTSD and disability of 0.079.Conclusion Patients with acute cerebral infarction have PTSD psychological state,but PTSD does not directly affect disability,and it exerts its influence on disability through depression and loneliness by the pathway of mediated effects,and improve the patients'life quality.