老年住院病人抑郁症状调查及心理干预

[目的]了解老年住院病人抑郁症状的发生率及相关因素,探讨针对其相关因素实施综合护理干预后的效果。[方法]对住院病人进行老年抑郁量表（GDs）评分,统计抑郁症状的发生率及相关因素,将有抑郁症状的病人随机分为干预组和对照组,对照组给予传统护理,干预组在传统护理基础上采用综合干预。[结果]住院病人抑郁症状发生率51．74％,干预组GDS评分较入院时有明显下降。[结论]综合干预可以有效地缓解抑郁症状。     

老年住院病人抑郁症状调查及心理干预

[目的]了解老年住院病人抑郁症状的发生率及相关因素,探讨针对其相关因素实施综合护理干预后的效果.[方法]对住院病人进行老年抑郁量表(GDS)评分,统计抑郁症状的发生率及相关因素,将有抑郁症状的病人随机分为干预组和对照组,对照组给予传统护理,干预组在传统护理基础上采用综合干预.[结果]住院病人抑郁症状发生率51.74%,干预组GDS评分较入院时有明显下降.[结论]综合干预可以有效地缓解抑郁症状.     

老年住院病人抑郁状态调查与影响因素分析

[目的]了解综合医院老年病科住院病人抑郁发生状况及其影响因素。[方法]采用自制调查问卷及老年抑郁量表(GDS,简洁版)对254例老年住院病人进行调查,并分析其相其因素。[结果]254例老年病人中180例(70.87%)无抑郁,轻度抑郁65例(25.59%),中重度抑郁9例(3.54%),抑郁总发生率29.13%。不同性别、文化程度、婚姻状况、慢性疼痛以及有无尿失禁、家人陪伴6个因素与抑郁发生率有关(P0.05或P0.01);家人陪伴、尿失禁、慢性疼痛是老年住院病人抑郁发生的危险因素(P0.05或P0.01)。[结论]住院老年病人抑郁发生率高,应重视人文关怀、社会支持与生活照料。更应加强尿失禁、慢性疼痛等老年综合征的评估、治疗及护理。     

高龄老年患者出院时抑郁程度及影响因素分析

目的探讨高龄老年患者出院时的抑郁水平及影响因素。方法采用老年抑郁量表和日常生活活动量表对银川市某三级甲等综合医院出院前316例高龄老年患者进行调查。结果高龄老年患者出院时抑郁症状的发生率为50.95%,抑郁评分为(5.02±3.41)分,明显高于国内常模(3.50±2.80)分(P0.01);多因素Logistic回归分析显示,曾经职业、经济来源、患病种类、生活自理能力是高龄老年患者出院时抑郁的影响因素。结论高龄老年患者出院时抑郁症状的发生率和抑郁水平均较高,护理人员应针对抑郁症状发生的影响因素,早期进行心理干预,以减少高龄老人抑郁症状的发生。     

呼吸科住院病人睡眠质量及影响因素调查分析

【】 目的 对呼吸科住院病人睡眠质量及影响因素进行调查分析,探讨改善患者睡眠障碍的有效护理方法。方法：采用匹兹堡睡眠质量指数量表( PSQI) 、医院焦虑抑郁量表(HAD)、自行设计呼吸科住院病人睡眠质量影响因素调查表,对294例呼吸科住院患者睡眠质量进行问卷调查,研究影响病人睡眠质量的原因及睡眠障碍病人焦虑、抑郁情绪 结果 引起睡眠障碍的主要原因依次为躯体因素、睡眠环境、抑郁情绪、药物因素,呼吸科住院病人睡眠障碍症状主要为入睡困难40例,占20.2%,不能熟睡39例,占19.7%,早醒63例,占31.8%,睡眠时间短56例,占28.3%。结论 呼吸科住院病人睡眠质量明显偏低,并存在不同程度的睡眠障碍,其中焦虑、抑郁情绪高于正常人,有效的护理措施应以生物、心理、社会医学模式为指导,积极、早期采用综合干预措施,以减轻患者心身症状,提高临床疗效。     

2341例居家老年慢性病患者抑郁症状及其影响因素的调查分析

目的 了解福州市鼓山镇居家老年慢性病患者抑郁症状发生情况及其影响因素.方法 利用流调中心用抑郁量表,采用整群抽样的方法,对抽取的15个行政单位(村或社)中2341例符合调查标准的居家老年慢性病患者行问卷调查.结果 该镇居家老年慢性病患者中抑郁症状发生率为15.7%,男性发生率为13.4%,女性20.7%.多因素分析结果示:不同性别、自理能力、感知觉功能、运动、患病种数、是否独居是其影响因素.结论 该镇居家老年慢性病患者抑郁症状较为常见,社区护理人员应针对其影响因素采取相应护理措施,促进居家老年慢性病患者身心健康.     

西安市养老机构老年人自我评价与抑郁症状发生率的相关性研究

目的探讨西安市养老机构老年人自我评价对抑郁症状发生率的影响。方法采用随机整群抽样的方法,使用老年抑郁量表及自行编制的一般情况调查表对西安市20所养老机构464名老年人进行问卷调查。结果自我评价差的老年人抑郁症状发生率明显高于自我评价好的老年人,差异有统计学意义（P〈0.05）。同时经济条件、社会地位、生活状态、居住环境进入回归方程,提示这4个因素为老年抑郁症状发生的影响因素。结论养老机构老年人抑郁发生率较高,且与老年人自我评价密切相关,护理人员应针对影响因素实施预防性干预,以减少老年人抑郁症状的发生。     

不同病房老年病人抑郁症状的比较与分析

应用ＣＥＳ－Ｄ量表对１３７例老年内科住院病人的抑郁症状进行问卷调查。结果显示，不同病房老年病人发生抑郁症状的程度不同；普遍病房较高于病房的老年病人抑郁症状发生率高，程度重（Ｐ〈０．０５），且以肾脏内科及神经内科的老年人尤为明显（Ｐ〈０．０１）。     

西安市城市社区老年人抑郁症状发生率及危险因素研究

[目的]研究西安城市社区老年抑郁症状的发生率及其危险因素。[方法]采取分层随机整群抽样方法,应用老年抑郁量表及自行编制的危险因素调查表对西安市6个社区1950名≥60岁的老年人进行问卷调查。[结果]老年抑郁症状发生率为24.9%,不同年龄、性别、职业、文化、家庭状态(丧偶、独居)之间抑郁症状发生率有统计学意义(P<0.05),年龄、经济收入、是否独居是老年抑郁症状发生的危险因素。[结论]城市社区老人心理健康状况不容乐观,贫困弱势群体是老年抑郁症状发生的高危人群,应作为重点干预对象。     

福州市鼓山镇城乡结合部老年人抑郁症状及影响因素调查

目的 探讨福州市鼓山镇城乡结合部老年人抑郁症状及其影响因素.方法 采用横断面调查法对该地区60岁及以上老年人进行抑郁症状调查和体格检查.结果 该地区老年人抑郁症状的发生率为15.3%;性别、ADL功能受损情况、患病种数是影响老年人抑郁症状发生率的主要因素.结论 福州市城乡结合部老年人的心理健康问题不容忽视,其抑郁症状的发生率受多方面因素的影响.老年女性、ADL功能受损、高患病种数者是老年人中的高危人群,是社区精神卫生保健的重点对象.     

抑郁症状在老年糖尿病患者衰弱与认知功能之间的中介作用

目的分析抑郁症状在老年2型糖尿病患者衰弱与认知功能之间的中介作用。方法采用衰弱表型(FP)、蒙特利尔认知评估量表(MoCA)、简版老年抑郁量表(GDS-15)对264例老年2型糖尿病患者进行调查。结果老年2型糖尿病患者认知功能障碍的发生率为56.1%,均分为(23.00±4.26)分,衰弱得分为(1.89±1.41)分,抑郁症状得分为(5.47±3.80)分。患者衰弱、抑郁症状得分与认知功能得分呈显著负相关(P<0.001),衰弱得分与抑郁症状得分呈显著正相关(P<0.001)。抑郁症状在衰弱与认知功能的关系中起部分中介作用,中介效应为-0.145,占总效应的29.9%。结论老年糖尿病患者认知功能障碍发生率高,减少个体衰弱、抑郁症状的发生是改善认知功能的有效途径。     

家庭功能与老年抑郁症状的相关性

目的对家庭功能状态与老年抑郁症状之间的相关性进行系统评价,为老年人群家庭功能管理提供循证依据。方法计算机全面检索中国知网、维普数据库、万方数据库、Pubmed、Web of Science,Embase,CINAHL,Cochrane Library等数据库,查找2018年7月之前所有老年人群家庭功能与抑郁症状之间相关性的文献。结果通过系统检索,共得到736篇相关文献,最终纳入8篇文献。系统评价结果表明,家庭功能与抑郁症状之间存在显著相关性。结论家庭功能与抑郁症状之间显著相关。关注老年人家庭功能,鼓励家庭成员关注老年人,是未来老年护理工作的一个方向。     

抑郁症患者焦虑症状、应付方式与人格特征的关系

背景:焦虑和抑郁的共病率各家报道不一,在抑郁症的病理心理学上,伴有焦虑症状的抑郁症患者的应付方式与人格及其与抑郁症状的关系等基本问题并不十分清楚。目的:分析伴有焦虑症状抑郁症患者的应付方式与人格的关系。设计:病例-对照观察。单位:中南大学湘雅二医院、湖南省脑科医院。对象:选择2002-06/2003-01在中南大学湘雅二医院、湖南省脑科医院住院的抑郁症患者88例。另选择中南大学湘雅二医院、中山大学部分职工及家属、临时工、学生中健康自愿者90人为正常对照组。方法:采用抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷进行调查评估。主要观察指标:①抑郁症组与正常对照组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。②有焦虑症状抑郁症组和无焦虑症状抑郁症组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。③抑郁症组各指标相关分析和逐步回归分析结果。结果:178名入选对象均进入结果分析。①抑郁症患者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分高于正常对照组,而艾森克人格问卷的内外向维度、积极应付方式得分低于对照组。②伴有焦虑症者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分明显高于不伴焦虑症者,积极应付方式得分低于无焦虑症组。③相关、回归分析表明抑郁症状的严重程度与焦虑自评量表、艾森克人格问卷的内外向维度及积极应付方式的关系更为密切。结论:①抑郁症患者的抑郁症状、焦虑症状、精神质较明显,偏内向,情绪不稳定,较少采用积极的应付方式。②有焦虑症状的抑郁症患者其抑郁症状较严重,精神质、神经质比较明显,较少采用积极的应付方式。③较少采用积极的应付方式可纳入人格特质的内外向维度之中。     

老龄便秘患者排便状况与心理因素的调查分析

目的分析老年便秘患者排便状况和心理因素对其的影响。方法应用抑郁自评量表（SDS）和焦虑自评量表（SAS）及记录排便日志的方法对59例高龄慢性特发性便秘患者（高龄组）及36例老龄便秘患者（老龄组）进行调查。结果高龄组患者较老龄组患者便秘程度严重,但老龄组自觉症状高于高龄组;高龄特发性便秘患者（高龄组）SDS标准总分和SAS标准总分均高于老龄组,两者之间有显著性差异（P〈0.05）。结论重视老年便秘患者排便状况和心理因素影响,针对性地护理高龄便秘患者。     

Social Support as a Mediator of Physical Disability and Depressive Symptoms in Chinese Elderly

The relationship between physical disability and depressive symptoms has been associated with social support. Different aspects of social support may play distinct roles in health-related quality of life. The aim of this study was to examine the mediation of social support in the relationship between physical disability and depressive symptoms among old people in Mainland China. Subjective support and utilization of support mediated the relationship between ADL and depressive symptoms, with the indirect effect of subjective support and utilization of support at 0.038 and 0.030 respectively (the total effect was 0.180). Subjective support was negatively associated with depressive symptoms in independent elderly people, utilization of support was negatively associated with depressive symptoms in partially dependent elderly people, and utilization of support had a greater association with geriatric depressive symptoms than subjective support in severely dependent elderly people. Social support mechanism and positive psychological intervention should be established and introduced in accordance with the physical disability of the elderly people, to protect them from depressive symptoms.     

Frequency and outcomes of painful physical symptoms in a naturalistic population with major depressive disorder: an analysis of pooled observational studies focusing on subjects aged 65 years and over

Aims: To estimate the frequency of painful physical symptoms (PPS) in elderly subjects (≥ 65 years) with major depressive disorder (MDD) in real‐world clinical conditions and to establish whether PPS are associated with poor depression outcomes, including more severe depression and worse health‐related quality of life (HRQoL). Methods: Observational studies of MDD that included assessment of PPS and elderly subjects were screened. Measures of PPS were based on the Somatic Symptom Inventory (SSI) or Visual Analogue Scale (VAS). Data from a variety of depressive symptom severity and HRQoL scales were used. Analysis cohorts were based on age [aged ≥ 65 years (elderly) or < 65 years (younger)] and/or PPS status (presence or absence); five subsets were used to examine specific outcomes in matched elderly subjects. Results: Data from seven studies (representing 26 countries) were collated. Of the 11,477 subjects, 14% were aged ≥ 65 years and 71% were classified as having PPS (PPS+). PPS were more frequent in elderly subjects (74% vs. 70% of younger subjects) and were positively associated with being female and Hispanic, and negatively associated with being East Asian in the elderly. The presence of PPS was associated with more severe clinical symptomatology and comparatively poorer HRQoL in elderly subjects. Conclusions: PPS, although frequent in younger MDD patients, were slightly more frequent in elderly MDD patients and associated with comparatively poorer clinical and functional outcomes. As elderly patients report somatic symptoms more readily than emotional symptoms, physicians should consider depression in addition to physical causes when PPS are present.     

抑郁症患者自我效能感、刻板印象及抑郁症状的关系研究

目的探讨抑郁症患者自我效能感、刻板印象及抑郁症状三者之间的相关性。方法选取2016年9月至2018年10月南京医科大学附属无锡精神卫生中心113例抑郁症患者为研究对象,均接受自我效能感[一般自我效能感量表(GSES评分)]、外显刻板印象、内隐刻板印象、抑郁症状[抑郁自评量表(SDS评分)、汉密尔顿抑郁量表(HAMD评分)]评估,根据自我效能感GSES评分分为高效能感组(n=41)与低效能感组(n=72),对比两组刻板印象(外显刻板印象、内隐刻板印象)评分、抑郁症状(SDS、HAMD)评分,分析抑郁症患者自我效能感、刻板印象及抑郁症状间相关性。结果高效能感组GSES评分为(27.62±1.37)分,低效能感组GSES评分为(19.17±1.46)分,组间比较差异有统计学意义(P<0.05);高效能感组积极外显刻板印象与积极内隐刻板印象评分高于低效能感组,消极外显刻板印象与消极内隐刻板印象评分低于低效能感组(P<0.05);高效能感组SDS评分、HAMD评分低于低效能感组(P<0.05);GSES评分与积极外显刻板印象、积极内隐刻板印象评分呈正相关(P<0.05),与消极外显刻板印象、消极内隐刻板印象评分呈负相关(P<0.05);GSES评分与SDS评分、HAMD评分呈负相关(P<0.05);积极外显刻板印象、积极内隐刻板印象评分与SDS评分、HAMD评分呈负相关(P<0.05),消极外显刻板印象、消极内隐刻板印象评分与SDS评分、HAMD评分呈正相关(P<0.05)。结论抑郁症患者自我效能感越高,则患者所持刻板印象越积极,抑郁症状亦较轻,而自我效能感越低则消极刻板印象、抑郁症状越严重,三者密切相关。提高患者自我效能感或改变刻板印象,对缓解患者抑郁症状具有积极意义。     

Depression in the elderly. Characteristics and clinical management

Major depression and clinically significant depressive symptoms occur commonly in the community-dwelling, medically ill, and institutionalized elderly. Both major depression and depressive symptoms need thorough evaluation and treatment because of the significant morbidity and mortality associated with these syndromes. Depression may be difficult to diagnose, especially in the medically ill elderly, because of the masking of depressive symptoms by somatic complaints or the presumption that symptoms are attributable to concurrent medical illness. Therefore, the clinician must be alert to the possibility of depression in the elderly patient. Although no specific diagnostic test is available, rating scales can be useful in screening for depression in the elderly patient. It is necessary to rule out medical illness or medications as contributing factors to depression. Psychotherapy and psychopharmacology, alone or in combination, are effective treatments for most elderly patients with depression. ECT is a safe and effective treatment for major depression in this population. Depression in the elderly is potentially a chronic and relapsing illness with significant associated medical and social morbidity. Because of their frequent contact with the elderly, nurses play a particularly important role in the diagnosis and treatment of depression. They need to recognize typical and atypical symptoms of depression and must be familiar with the potential side effects of antidepressant treatment. Close monitoring for these potential side effects can minimize disability. By working as a team with physicians, psychologists, and others, nurses have a necessary role in the care of the elderly depressed patient.