上海市宝山区肺结核患者心理状态及其影响因素分析

doi:10.3969/j.issn.1000-6621.2021.04.014

摘要/Abstract

摘要：

目的分析上海市宝山区肺结核患者抑郁心理状态和焦虑心理状态的主要影响因素,为提出有针对性的干预措施提供依据。方法选择2018年1月1日至12月31日上海市宝山区登记报告的487例确诊肺结核患者,排除拒绝调查、因在外地治疗无法完成调查者,选取356例肺结核患者作为研究对象,采用抑郁自评量表(PHQ-9)、焦虑自评量表(GAD-7)、社会支持水平调查量表(SSRS)对肺结核患者进行调查。调查共发放问卷356份,回收356份,有效问卷356份,有效率为100.0%。结果肺结核患者中抑郁心理状态的检出率为14.6%(52/356),焦虑心理状态检出率为6.2%(22/356)。单因素分析结果显示,中等社会支持者的抑郁心理状态比例为48.1%(25/52),明显高于高社会支持者(9.6%,5/52),差异有统计学意义(χ²=14.405,P=0.001);初中学历、收入<2000元、低/中等社会支持者的焦虑心理状态检出率分别为36.4%(8/22)、59.1%(13/22)、50.0%(11/22),分别高于高中学历(13.6%,3/22)、收入≥5000元(9.1%,2/22)、高等社会支持(0.0%,0/22),差异均有统计学意义(χ²值分别为10.010、21.884、12.327,P值分别为0.018、<0.001、0.002)。多因素logistic回归分析结果显示,中等社会支持水平(以高等社会支持水平为参照,OR=3.782,95%CI:1.332~10.738)为抑郁心理状态的危险因素,收入水平<2000元(以收入水平≥5000元为参照,OR=8.415,95%CI:1.800~39.334)为焦虑心理状态的危险因素。结论上海市宝山区肺结核患者焦虑心理状态、抑郁心理状态的异常率较高。社会支持水平的提高有助于缓解肺结核患者的抑郁心理状态,收入水平的提高可以缓解肺结核患者的焦虑心理状态。

关键词: 结核,肺, 抑郁, 焦虑, 因素分析,统计学

Abstract:

Objective To analyze the main factors of depression and anxiety among pulmonary tuberculosis (PTB) patients in Baoshan District of Shanghai, so as to provide evidence for targeted interventions. Methods Four hundred and eighty-seven patients with PTB registered in Baoshan District of Shanghai from January 1 to December 31, 2018, those who refused or unable to complete the investigate were excluded, a total of 356 patients with PTB were selected. We used Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), Social Support Rate Score (SSRS) for investigation. A total of 356 questionnaires were distributed, all the questionnaires were collected and valid, with an effective rate of 100.0%. Results The detection rate of depression and anxiety among PTB patients were 14.6% (52/356) and 6.2% (22/356) respectively. Univariate analysis showed that 48.1% (25/52) of middle social supporters had depression, which was significantly higher than the high social supporters (9.6%, 5/52; χ²=14.405, P=0.001). The detection rates of anxiety within junior high school education, income under 2000 yuan and low/middle social supporters were 36.4% (8/22), 59.1% (13/22) and 50.0% (11/22) respectively, which were significantly higher than those with senior high school education (13.6%, 3/22), income above 5000 yuan (9.1%, 2/22) and high social supporters (0.0%, 0/22), the difference was statistically significant (χ²=10.010, 21.884, 12.327, P=0.018, <0.001, 0.002). Multivariate logistic regression analysis showed that medium social support (high social support as reference, OR=3.782, 95%CI: 1.332-10.738) was the risk factor for depression, income <2000 yuan (income >5000 as reference, OR=8.415, 95%CI: 1.800-39.334) were the risk factors for anxiety. Conclusion The abnormal rate of anxiety and depression of PTB patients in Baoshan District of Shanghai is relatively high. The improvement of social support is helpful to alleviate the depression of patients and the income incense could attribute to relieve the anxiety of patients.

Key words: Tuberculosis, pulmonary, Depression, Anxiety, Factor analysis, statistical

马志涛, 王娜, 吕阳, 胡伟宏, 陈昶, 何凡, 沈鑫, 刘效峰. 上海市宝山区肺结核患者心理状态及其影响因素分析[J]. 中国防痨杂志, 2021, 43(4): 378-384. doi: 10.3969/j.issn.1000-6621.2021.04.014

MA Zhi-tao, WANG Na, LYU Yang, HU Wei-hong, CHEN Chang, HE Fan, SHEN Xin, LIU Xiao-feng. The research on psychological status of pulmonary tuberculosis patients and influencing factors in Baoshan District, Shanghai[J]. Chinese Journal of Antituberculosis, 2021, 43(4): 378-384. doi: 10.3969/j.issn.1000-6621.2021.04.014

图/表 4

表1

表2

356例研究对象心理状态调查结果

特征	抑郁心理状态(52例)				焦虑心理状态(22例)
特征	例数	构成比(%)	χ²值	P值	例数	构成比(%)	χ²值	P值
年龄组(岁)			4.103	0.392			3.095	0.542
17~29	9	17.3			2	9.1
30~39	11	21.2			5	22.7
40~49	3	5.8			2	9.1
50~59	10	19.2			4	18.2
60~90	19	36.5			9	40.9
性别			0.155	0.694			2.370	0.124
男	36	69.2			18	81.8
女	16	30.8			4	18.2
婚姻			0.041	0.839			0.008	0.930
已婚	38	73.1			16	72.7
未婚	14	26.9			6	27.3
教育水平			5.498	0.139			10.010	0.018
小学	9	17.3			7	31.8
初中	20	38.5			8	36.4
高中	11	21.1			3	13.6
大专及大学	12	23.1			4	18.2
收入水平(元)			3.770	0.438			21.884	<0.001
<2000	14	26.9			13	59.1
2000~2999	7	13.5			2	9.1
3000~3999	13	25.0			2	9.1
4000~4999	8	15.4			3	13.6
≥5000	10	19.2			2	9.1
户籍			0.121	0.728			0.332	0.564
本地	36	69.2			16	72.7
外地	16	30.8			6	27.3
社会支持			14.405	0.001			12.327	0.002
低等	22	42.3			11	50.0
中等	25	48.1			11	50.0
高等	5	9.6			0	0.0
特征	抑郁心理状态(52例)				焦虑心理状态(22例)
特征	例数	构成比(%)	χ²值	P值	例数	构成比(%)	χ²值	P值
就诊延迟			1.190	0.275			0.554	0.457
有	24	46.2			7	31.8
无	28	53.8			15	68.2
痰涂片结果			2.197	0.138			2.757	0.097
阳性	20	38.5			10	45.5
阴性	32	61.5			12	54.5
痰培养结果			3.315	0.069			0.099	0.753
阳性	8	15.4			5	22.7
阴性	44	84.6			17	77.3
肺结核空洞			1.357	0.244			0.332	0.564
有	10	19.2			4	18.2
无	42	80.8			18	81.8
治疗方案^a			0.568	0.451			0.924	0.336
2H-R-Z-E/4H-R	48	92.3			21	95.5
2H-R-Z-E-S/6H-E-R	4	7.7			1	4.5
治疗情况			1.089	0.297			1.176	0.278
初治	0	0.0			0	0.0
复治	52	100.0			22	100.0
耐药情况			0.776	0.378			0.889	0.346
耐药	51	98.1			22	100.0
非耐药	1	1.9			0	0.0

表2

表3

表4

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序号	变量定义	赋值方法
X₁	性别	男=1;女=0
X₂	年龄	17~29岁=1;30~39岁=2;40~49岁=3;50~59岁=4;60~90岁=5
X₃	教育水平	小学=1;初中=2;高中=3;大专及大学=4
X₄	收入水平	<2000元=1;2000~2999元=2;3000~3999元=3;4000~4999元=4;≥5000元=5
X₅	社会支持	低等=1;中等=2,高等=3
Y₁	抑郁	有=1,无=0
Y₂	焦虑	有=1,无=0

因素	β值	值	Wald χ²值	P值	OR(95%CI)值
抑郁
社会支持
高等					1.00
中等	1.330	0.532	6.245	0.012	3.782(1.332~10.738)
低等	0.213	0.515	0.171	0.679	1.237(0.451~3.397)
焦虑
收入(元)
≥5000					1.00
4000~4999	1.375	0.942	2.132	0.144	3.954(0.625~25.026)
3000~3999	0.163	1.015	0.026	0.872	1.177(0.161~8.602)
2000~2999	0.704	1.022	0.474	0.491	2.022(0.273~14.990)
<2000	2.130	0.787	7.329	0.007	8.415(1.800~39.334)