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目的了解社区在册糖尿病、高血压患者抑郁和焦虑症状阳性率及其影响因素,为后期干预提供依据。方法 2012年8月—2013年2月从上海2个区所辖3家社区卫生服务中心在册的2型糖尿病和高血压患者中随机抽样,采用患者健康问卷(PHQ–9)和广泛性焦虑自评量表(GAD–7)评估患者的抑郁和焦虑症状,并探讨其影响因素。结果共调查糖尿病、高血压患者8 813例,抑郁症状(PHQ–9≥5分)和焦虑症状(GAD–7≥5分)阳性率分别为14.7%和7.0%,抑郁或焦虑症状任一阳性的比例为16.0%;其中糖尿病合并高血压患者的阳性率最高(抑郁19.7%,焦虑9.4%,抑郁或焦虑21.3%),其次是仅有糖尿病的患者(抑郁16.3%,焦虑7.4%,抑郁或焦虑17.7%),仅有高血压患者最低(抑郁12.3%,焦虑5.9%,抑郁或焦虑13.4%);多因素回归分析显示,受教育水平低、离婚/丧偶、并发症多、半年内综合性医院就诊次数多、以及糖尿病合并高血压患者的抑郁或焦虑阳性率更高。结论社区糖尿病和高血压患者中抑郁和焦虑症状较为常见,应该在社区卫生服务中逐步纳入相应问题的筛查和干预,以改善该人群的健康水平。
Abstract：Objective To examine the positive rate and influential factors of anxiety and depressive symptoms among community patients with hypertension or diabetes and to provide evidences for future interventions. Methods Patients with type-2 diabetes or hypertension registered in 3 community health service centers in 2 districts of Shanghai were recruited with cluster random sampling for a self-administered questionnaire survey during the period from August 2012 to February2013. We identified participants with depressive or anxiety symptoms using Patient Health Questionnaire-9(PHQ-9) and Generalized Anxiety Disorder Scale-7(GAD-7) and explored the factors related to these symptoms. Results A total of 8 813 diabetes or hypertension patients completed the survey. The proportion of patients with depressive symptoms(score of PHQ-9≥ 5) and anxiety symptoms(score of GAD-7 ≥ 5) were 14.7 % and 7 %, respectively, and 16.0 % of the patients had either depressive or anxiety symptoms. The positive rates were the highest among the patients with both diabetes and hypertension(19.7 % for depression, 9.4 % for anxiety, and 21.3 % for depression or anxiety), followed by those among the patients with only hypertension(16.3 % for depression, 7.4 %, for anxiety, and 17.7 % for depression or anxiety); and the positive rates were lowest among the patients with only diabetes(12.3 % for depression, 5.9 % for anxiety, and 13.4 % for depression or anxiety). Multivariate regression analyses indicated that depressive or anxiety symptoms were more prevalent in patients with lower education, divorced or widowed, with more complications, having more general hospital visits within previous six months, and with comorbided diabetes and hypertension. Conclusion Depressive and anxiety symptoms are common in community-dwelling patients with hypertension or diabetes. Screening and intervention on these symptoms should be gradually incorporated into community health services to improve the health status of the patients.
[1]Nouwen A.Depression and diabetes distress[J].Diabet Med,2015,32(10):1261-1263.
[2]Smith KJ,Beland M,Clyde M,et al.Association of diabetes with anxiety:a systematic review and meta-analysis[J].J Psychosom Res,2013,74(2):89-99.
[3]Li Z,Li Y,Chen L,et al.Prevalence of depression in patients with hypertension:a systematic review and meta-analysis[J].Medicine(Baltimore),2015,94(31):e1317.
[4]Long J,Duan G,Tian W,et al.Hypertension and risk of depression in the elderly:a meta-analysis of prospective cohort studies[J].JHum Hypertens,2015,29(8):478-482.
[5]Pan Y,Cai W,Cheng Q,et al.Association between anxiety and hypertension:a systematic review and meta-analysis of epidemiological studies[J].Neuropsychiatr Dis Treat,2015:111121-1130.
[6]曾庆枝,何燕玲,石振宇,等.综合心理干预对社区慢性病患者的效果评价:一项源于社区的整群、随机、对照试验[J].上海精神医学,2016,28(2):72-85.
[7]卞崔冬,何筱衍,钱洁,等.患者健康问卷抑郁症状群量表在综合性医院中的应用研究[J].同济大学学报:医学版,2009,30(5):136-140.
[8]韩晶,殷晓梅,徐斐,等.南京市浦口地区高血压人群抑郁和焦虑状况的病例对照研究[J].中华流行病学杂志,2008,29(2):125-127.
[9]Spitzer RL,Kroenke K,Williams JB.Validation and utility of a self-report version of PRIME-MD:the PHQ primary care study.Primary Care Evaluation of Mental Disorders.Patient Health Questionnaire[J].JAMA,1999,282(18):1737-1344.
[10]徐勇,吴海苏,徐一峰病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用--信度与效度分析[J].病人健康问卷抑郁量表(PHQ-9)在社区老年人群中的应用--信度与效度分析[J].上海精神医学,2007,19(5):257-259,276.
[11]Kroenke K,Spitzer RL,Williams JB,et al.The Patient Health Questionnaire Somatic,Anxiety,and Depressive Symptom Scales:a systematic review[J].Gen Hosp Psychiatry,2010,32(4):345-359.
[12]Spitzer RL,Kroenke K,Williams JB,et al.A brief measure for assessing generalized anxiety disorder:the GAD-7[J].Arch Intern Med,2006,166(10):1092-1097.
[13]何筱衍,李春波,钱洁,等.广泛性焦虑量表在综合性医院的信度和效度研究[J].上海精神医学,2010,22(4):200-203.
[14]Patten SB.Long-term medical conditions and major depression in a Canadian population study at waves 1 and 2[J].J Affect Disord,2001,63(1-3):35-41.
[15]Bhattacharya R,Shen C,Sambamoorthi U.Excess risk of chronic physical conditions associated with depression and anxiety[J].BMC Psychiatry,2014,14:10.
[16]Dejean D,Giacomini M,Vanstone M,et al.Patient experiences of depression and anxiety with chronic disease:a systematic reviewand qualitative meta-synthesis[J].Ont Health Technol Assess Ser,2013,13(16):1-33.
[17]马骏,刘同涛,贾崇奇.冠心病患者焦虑抑郁情绪及影响因素分析[J].中国公共卫生,2010,26(5):555-556.
[18]冯大洋,曾臻,廖芳芳,等.2型糖尿病住院患者焦虑、抑郁状况影响因素分析[J].中国卫生统计,2010,27(2):129-132.
[19]张帆,胡大一,杨进刚,等.高血压合并焦虑、抑郁的发病率和相关危险因素分析[J].首都医科大学学报,2005,26(2):140-142.
[20]Ringoir L,Pedersen SS,Widdershoven JW,et al.Prevalence of psychological distress in elderly hypertension patients in primary care[J].Neth Heart J,2014,22(2):71-76.
[21]van Dooren FE,Denollet J,Verhey FR,et al.Psychological and personality factors in type 2 diabetes mellitus,presenting the rationale and exploratory results from The Maastricht Study,a population-based cohort study[J].BMC Psychiatry,2016,16:17.
[22]Stompe T,Ritter K,Schrank B.Depression and culture[J].Neuropsychiatr,2009,23(4):253-262.
[23]Moulton CD,Pickup JC,Ismail K.The link between depression and diabetes:the search for shared mechanisms[J].Lancet Diabetes Endocrinol,2015,3(6):461-471.
[24]李,孙学礼.下丘脑-垂体-肾上腺轴与抑郁症的相关性[J].中国临床康复,2006,10(42):130-133.
[25]Talbot F,Nouwen A.A review of the relationship between depression and diabetes in adults:is there a link?[J].Diabetes Care,2000,23(10):1556-1562.
[26]Bajko Z,Szekeres CC,Kovacs KR,et al.Anxiety,depression and autonomic nervous system dysfunction in hypertension[J].J Neurol Sci,2012,317(1-2):112-116.
[27]Trento M,Raballo M,Trevisan M,et al.A cross-sectional survey of depression,anxiety,and cognitive function in patients with type2 diabetes[J].Acta Diabetol,2012,49(3):199-203.
[28]阎爽,李强,孙予债.糖尿病患者伴抑郁状况的多因素分析[J].中国临床康复,2005,9(12):1-3.
[29]van Steenbergen-Weijenburg KM,van Puffelen AL,Horn EK,et al.More co-morbid depression in patients with type 2 diabetes with multiple complications.An observational study at a specialized outpatient clinic[J].Diabet Med,2011,28(1):86-89.
[30]Tovilla-Zarate C,Juarez-Rojop I,Peralta Jimenez Y,et al.Prevalence of anxiety and depression among outpatients with type2 diabetes in the Mexican population[J].PLo S One,2012,7(5):e36887.
[31]万爱华,修新红,任志伊,等.围绝经期女性抑郁焦虑症及影响因素分析[J].中国公共卫生,2007,23(10):1239-1240.
[32]Weiss Wiesel TR,Nelson CJ,Tew WP,et al.The relationship between age,anxiety,and depression in older adults with cancer[J].Psychooncology,2015,24(6):712-717.
[33]Blank TO,Bellizzi KM.A gerontologic perspective on cancer and aging[J].Cancer,2008,112(11 Suppl):2569-2576.
基本信息:
中图分类号:R544.1;R587.1
引用信息:
[1]高炬,曾庆枝,何燕玲,等.上海市2012年社区在册糖尿病和高血压患者抑郁、焦虑阳性率及其影响因素[J].中国公共卫生,2018,34(02):223-229.
基金信息:
上海市公共卫生体系建设三年行动计划(2011—2013)–重点人群心理健康服务(GWIII-30)
2017-06-30
2017-06-30
2017-06-30