心理社会因素对产后抑郁的影响

产妇的个性特征、认知和应对方式、自我效能感及社会支持、产妇产前的情绪和心理状态还有一些社会因素都与产后抑郁有着密切的联系。本文通过系统分析心理社会因素对产后抑郁的影响,详细地列出心理社会的各个因素及其对产后抑郁的影响,为预防产后抑郁的发生制定出一套科学、合理的心理综合干预方案奠定理论基础。     

产后抑郁的研究现状及其社会心理影响因素

文章综述了精神科及妇产科医生在评估、诊断产后抑郁的不同之处，并介绍了近几年产后抑郁与心理社会因素关系的研究进展。     

重性抑郁障碍患病率的性别差异

目的了解重性抑郁障碍的患病率及其性别差异。方法采用多阶段分层整群抽样方法随机抽取≥18周岁的人群10073名,以改编后的一般健康问卷12项（GHQ-12）为筛选工具,以美国精神障碍诊断与统计手册-第4版（DSM-IV）轴I障碍定式临床检查病人版（SCID-I/P）为调查的诊断工具。功能状况评价采用大体功能评定量表（GAF）。结果重性抑郁障碍的终生患病率为41.90‰（95‰CI：37.77‰～46.04‰）,时点患病率为26.38‰（95‰CI：23.08‰～29.69‰）。女性终生及时点患病率均明显高于男性（P〈0.01）,农村女性的终生和时点患病率均明显高于农村男性（P〈0.01）。女性30岁以上患病率较高。重性抑郁障碍与其他精神障碍共病比率男性56.10%,女性55.95%,两性间差异无统计学意义（P〉0.05）。心理、社会和职业功能受损程度重度发生率男性为68.29%,女性48.81%,男性高于女性（P〈0.05）。结论重性抑郁障碍是一种患病率较高的精神障碍,女性,特别是农村女性的患病率高,男性心理、社会及职业功能损伤程度的重度发生率高于女性。     

心理社会因素及干预在高血压发生和治疗中的作用

目的 探讨心理社会因素在高血压发生和治疗过程中的作用及综合心理干预的临床意义.方法 对40例高血压患者回顾性测评和社会再适应评定量表(SRRS),并随机分为综合心理干预组和对照组,评定、比较焦虑自评量表(SAS)、抑郁自评量袁(SDS)、ABP、住院时间及临床疗效.结果 ①高血压患者SRRS均大于150生活变化单位(L...     

个体和社会功能量表中文版在抑郁障碍患者中的信效度

目的:考察个体和社会功能量表中文版(Chinese version of the Personal and Social Performancescale,PSP-CHN)在抑郁障碍患者中的信度和效度。方法:收集74例符合《精神障碍诊断和统计手册》第四版(Diagnostic and Statistical Mannual of Mental Disorders,Fourth Edition,test revision,DSM-IV-TR)抑郁障碍诊断标准的门诊或住院患者,其中6例参加了研究者之间一致性培训,68例(急性期42例,稳定期26例)进行了大体功能量表(Global Assessment of Functioning Scale,GAF))、Hamilton抑郁量表17项(Ham-ilton Depression Rating Scale17items,HAMD-17)和PSP-CHN检查,分析PSP-CHN量表评估抑郁障碍患者的内部一致性、PSP-CHN与GAF的一致性(效标效度)以及与患者疾病严重度的相关性(关联效度),32例患者在首次PSP-CHN评估后的5～7天内,由另一名研究者对其进行第2次检查,评价PSP-CHN在抑郁障碍患者中的重测信度。26例HAMD17评分17分的患者,接受标准化治疗8周后,评估HAMD17评分和PSP-CHN的评分变化。结果:PSP-CHN量表的内部一致性Cronbachα系数为0.71,PSP-CHN总分的研究者之间一致性Kappa值为0.82(ICC=0.94),重测一致性ICC=0.90。PSP-CHN总分与GAF总分呈正相关(r=0.95,P0.001),与HAMD-17总分负相关(r=-0.54),急性期和稳定期与PSP-CHN总分相关的抑郁因子不同。结论:个体和社会功能量表中文版可以评价抑郁症患者的个体和社会功能,但是总体信度低于在精神分裂症患者中的评估。     

缓解期重性抑郁与心境恶劣患者人格特征及人格障碍研究

目的：研究重性抑郁症(MDD)和心境恶劣障碍(DD)患者在人格维度、人格特质水平及人格模型及人格障碍倾向性方面的特征。方法：采用NEO-PI-R个性调查表及人格诊断问卷(PDQ^ 4)对58例MDD和57例DD患者及115例正常人进行测试。结果：MDD和DD在NEO-PI-R的五因素人格模型的外向性、严谨性得分均低于正常组，DD患者的神经质分高于MDD患者，MDD患者的顺同性分高于正常组；在30个特质层面上，MDD和DD与正常组之间有显著性差异，DD患者的N1(焦虑)、N4(自我意识)分明显高于MDD患者，E4(热情性)、A1(信任感)分明显低于MDD患者；MDD和DD在PDQ^ 4的边缘型(BDL)、回避型(AVD)、抑郁型(DEP)、分裂性(SZD)、偏执型(PND)、强迫型(OBC)人格障碍得分明显高于正常组，DD患者在分裂型得分明显高于MDD患者，在表演型(HST)分明显高于正常组。结论：MDD和DD的人格特征既有共同的之处，也存在差异。两者均伴有人格障碍，但DD患者比MDD患者人格障碍更明显。     

性心理障碍的社会和心理分析

性心理障碍，是人类社会的一个老问题。由于时代的推动和性观念的变迁，人们的性意识发生了新的变化，给某些人的性行为和性心理带来动荡与影响。新的性意识与旧意识发生冲突时，就造成了某些人的注心理障碍。本文试就住心理咨询中一部分人性心理障碍的社会和心理因素，作一简单分析。1性关系的合作与妥协性衡量性行为的好坏，主要标准就是看性生理和住心理体验。一般来说，双方均能从性行为中得到满足最好，性行为的失败是指一方或双方都没有得到满足．在我国由于重男轻女传统思想的影响，在性观念中，男子似乎没有合作妥协的必要，而女人…     

抑郁障碍患者非理性信念特征及相关因素的研究

目的:探讨抑郁障碍患者非理性信念的特征及相关因素.方法:采用非理性信念量表分别对50例抑郁障碍患者及50例正常人进行评定:采用抑郁自评量表、艾森克人格问卷对50例抑郁障碍患者进行评定.结果:①与正常对照,患者的非理性信念水平显著偏高,在低挫折耐受、概括化评论及总分有统计学差异(P<0.05);②与男性患者对照,女性非理性信念水平显著偏高,在低挫折耐受分量表有显著性差异(P<0.05);③患者非理性信念与人格特质具有显著相关(P<0.05).结论:抑郁障碍患者存在非理性信念;非理性信念与人格特质具有一定相关性.     

军队医院住院医师睡眠质量的心理社会因素

目的调查驻军中心医院住院医师的睡眠质量及心理社会影响因素。方法应用整群覆盖调查方式,以匹兹堡睡眠指数量表(PSQI)、艾森克人格问卷(EPQ)、生活事件量表(LES)、应付方式量表、社会支持量表(SSRS)对被试群体进行调查,结果以成组t检验、多元逐步回归分析方式进行统计学处理。结果①PSQI:被试群体中44.50%存在睡眠障碍,睡眠障碍组7个因子及总分均显著高于中国常模(t=4.218～36.477,P<0.01);②EPQ:睡眠障碍组内外向(t=2.531,P<0.05)极显著低于非睡眠障碍组,而神经质分(t=3.213,P<0.01)极显著高于后者;③LES:睡眠障碍组在"家庭问题"(t=2.398,P<0.05)、"正性事件"(t=2.617,P<0.01)、"负性事件"(t=2.617,P<0.01)、"生活事件总和"(t=2.777,P<0.05)4项得分均显著高于非睡眠障碍组;④应付方式问卷:睡眠障碍组在"解决问题"(t=3.293,P<0.01)、"求助"(t=3.105,P<0.01)2项得分显著低于非睡眠障碍组,而在"自责"(t=3.105,P<0.01)、"幻想"(t=3.216,P<0.01)、"回避"(t=3.163,P<0.01)、"合理化"(t=2.963,P<0.01)4项得分显著高于后者;⑤SSRS:睡眠障碍组在"客观支持"(t=5.544,P<0.01)、"主观支持"(t=3.265,P<0.01)、"支持利用度"(t=6.366,P<0.01)、"总分"(t=2.456,P<0.05)4项得分均显著低于非睡眠障碍组;⑥PSQI的影响因素:所有入选因素中,以"神经质"对因变量的出现频率最高,其次为"负性事件"、"客观支持"、"幻想",而"解决问题"为唯一的保护性因素。结论军队医院住院医师的睡眠障碍严重,且与情绪不稳定性、高生活事件数量、不成熟应对方式、社会支持程度缺乏等因素密切相关。     

Genetic and environmental factors in major depression

A study of 48 individuals with major depression in a sample of 443 adoptees has shown that depression is positively but not significantly correlated with a biologic background of affective disorder. Both primary and secondary depression was positively and significantly correlated with several environmental factors. In males, an adoptive home where another individual had an alcohol problem increased depression; in females, death of an adoptive parent prior to adoptee age 19 and an adoptive family where another individual had a behavior disturbance increased depression. Results suggest that the environmental factors occurring prior to adoptees age 18 predisposed to depression.     

Rumination, mood and social problem-solving in major depression

BACKGROUND: Ruminating when depressed is thought to lower mood and impair problem-solving, while distraction is thought to alleviate mood and assist problem-solving. The present study investigates each of these proposals using both naturally occurring and experimentally induced rumination and distraction in a sample of patients with major depression. METHOD: Thirty-six patients with major depression and 36 control participants were randomly allocated to either a rumination or distraction induction condition. Levels of trait rumination and distraction were measured at baseline, mood and problem-solving were measured before and after the inductions. RESULTS: In terms of trait measures, depressed patients with higher levels of trait rumination reported poorer mood and gave less effective problem solutions than those who were less ruminative. Trait distraction was not associated with mood or problem-solving. In terms of induced responses, depressed patients who were made to ruminate experienced a deterioration in their mood and gave poorer problem solutions. For those receiving the distraction induction, mood improved in all patients and problem-solving improved in patients who were not naturally ruminating at a high level. Neither induction had an impact on mood or problem-solving in control participants. CONCLUSIONS: Treatment for depression associated with adverse life events may need to target rumination as well as problem-solving deficits if interventions are to be effective. The differential effects of self-applied versus experimentally induced distraction require further investigation. Future research will need to consider that high levels of trait rumination may interfere with the impact of experimental inductions.     

Genetic factors in the sex ratio of major depression

A twofold increase in the prevalence of depression among women has been consistently observed. Several possible explanations, including methodological, endocrine, psychosocial, and genetic factors, have been proposed for the increased rates of depression among women. This paper describes the analysis of data from a family-genetic study of depressed probands to examine whether genetic factors can explain the preponderance of depressed females. Our data indicate that the excess of females with major depression cannot be attributed to increased genetic loading for depression in women. Other factors which may explain increased rates of major depression in women are discussed.     

Segregated neural representation of psychological and somatic-vegetative symptoms in severe major depression

Objective: The Beck Depression Inventory (BDI) is probably the most widely used depression scale. It has been suggested that it contains a two-factor structure measuring cognitive-affective (i.e. psychological) and somatic-vegetative depressive symptoms. In this study we aim to evaluate these factors by probing for their neural correlates. Methods: Neural responses evoked by emotional perception, relative to an emotional judgment task, were measured using functional magnetic resonance imaging (fMRI) in 20 medication-free patients with severe MDD. Psychological and somatic-vegetative symptoms were evaluated with the BDI. Results: Psychological symptoms correlated with signal changes in the dorsomedial and right ventrolateral prefrontal cortex, while somatic-vegetative symptoms correlated with signal changes in the pre-genual anterior cingulate cortex. Conclusions: These preliminary findings demonstrate segregated neural representation of psychological and somatic-vegetative symptoms of MDD in different cortical regions. Thus, our results indicate that the two-factor structure of the BDI is related to distinct neural correlates.     

慢性酒依赖患者社会心理学因素分析

目的探讨心理社会因素对慢性酒依赖的影响。方法对40例慢性酒依赖患者(研究组)和40例健康人(对照组),采用艾森克个性问卷、社会支持量表、生活时间量表进行评定分析。结果研究组艾森克个性问卷E维度得分明显低于对照组,N维度得分明显高于对照组;社会支持量表的客观支持、支持利用度及社会支持总分研究组低于对照组;生活事件量表的总的生活事件、负性生活事件得分研究组明显高于对照组。结论心理社会因素对慢性酒依赖有重要的影响,对其进行心理干预显得尤为重要。     

Social support and social negativity findings in depression: perceived responsiveness to basic psychological needs

Social relationships can influence the well-being of depressed individuals, both positively and negatively. However, processes underlying these diverse effects are not clear. Drawing from self-determination theory (Deci & Ryan, 2000), we propose that the extent to which social relationship partners are perceived to fulfill or undermine basic psychological needs serves to explain both the positive and negative effects that social relationships have on the well-being of depressed individuals. This proposal forms a major tenet of a model that integrates previous models of social support mechanisms, namely, the buffering hypothesis and the main effects hypothesis. This model thus explains both the positive and negative effects that social relationships have on the well-being of depressed individuals. Presentation of this model is followed by a discussion of the possible effects of two characteristics of depressed individuals (i.e., stress generation and negative cognitive style) on their perceptions of relationship partners' responsiveness to basic psychological needs. We conclude with suggestions for future research and possible clinical applications.     

Prognostic factors in major depression: a long-term follow-up study of 323 patients

BACKGROUND: Optimal long-term treatment of major depression should assess the background factors affecting remission and recurrent episodes. The duration and number of previous depressive episodes has been shown to be important for recurrence. This long-term prospective study of patients with major depression assessed the prognostic effect of variables related to childhood, social life and occupation. METHODS: The study examined 323 patients in two follow-up examinations 12-25 years from the initial examination to the second follow-up. Stepwise logistic regression was used to evaluate the prognostic effect for depression at the second follow-up. RESULTS: The risk of depression at the second follow-up was associated with several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one's own occupation. LIMITATIONS: The patient group was selected from the practice of only one psychiatrist. CONCLUSIONS: Several psychosocial factors in childhood, female gender, social isolation and a negative attitude towards one's own occupation have previously been shown to be associated with the risk of depression. The results in this study suggest that these factors are also important in predicting the outcome of a major depressive episode and the risk of recurrent episodes.     

Beyond major depression

BACKGROUND: The DSM concept of 'major depression' has accrued increased status but demonstrated limited utility since inception. METHOD: An historical overview of models of depression and the initially perceived advantages presented by the concept of 'major depression' are presented before detailing its limitations in application. RESULTS: Challenges to the utility of 'major depression' are provided by examining its conceptual model, its validity, its utility and the limited information generated in aetiological and treatment efficacy studies. CONCLUSION: It is argued that the concept of 'major depression' has led to sterility in depression research and clinical practice, and that there is a need for a paradigm shift in modelling and classifying the depressive disorders.