慢性心力衰竭患者D型人格对焦虑抑郁、社会支持和生活质量的影响

目的:探讨慢性心力衰竭(CHF)患者D型人格对焦虑抑郁、社会支持和生活质量的影响。方法:依据D型人格量表(DS-14)把CHF患者分为D型人格组和非D型人格组,两组均在接受治疗前进行一般状况调查表、焦虑自评量表（SAS)、抑郁自评量表（SDS)、社会支持评定量表(SSRS)和明尼苏达心力衰竭生活质量量表(MLHFQ)的测试。结果:①CHF患者中D型人格、焦虑、抑郁分别占34.0%、36.7%、46.7%。②D型人格组焦虑、抑郁的检出率(分别为70.6%和80.4%)均明显高于非D型人格组(分别为19.2%和29.3%,均P<0.01);D型人格组的社会支持得分（34.00±7.18）明显低于非D型人格组(41.57±7.61,P<0.01);D型人格组的生活质量得分（58.61±17.12）明显高于非D型人格组(36.67±17.63,P<0.01)。结论:D型人格的CHF患者体验更多的焦虑抑郁情绪,得到更少的社会支持,拥有较低水平的生活质量。     

抑郁、心理弹性对老年人自我护理能力的影响及衰弱的调节效应

目的探讨抑郁、心理弹性对老年人自我护理能力的影响及衰弱的调节效应。方法采用简版老年抑郁量表(GDS)-15、心理弹性量表简表(RS)-14、老年人自我护理能力量表(SASE)对518名老年人进行调查。结果老年人自我护理能力总分为(70. 90±8. 97)分;衰弱老年人的自我护理能力明显低于健康老年人;老年人心理弹性与抑郁、自我护理能力呈相关关系(r=-0. 47、0. 60,P<0. 01);抑郁与自我护理能力也呈相关关系(r=-0. 50,P<0. 01);心理弹性在抑郁和自我护理能力之间具有部分中介效应;衰弱在老年人的抑郁、心理弹性和自我护理能力关系中起到调节效应。结论心理弹性在老年人抑郁情绪和自我护理能力间具有中介作用,有无衰弱在三者关系间起调节效应,临床护理工作中应提高存在抑郁风险老年人的心理弹性水平,从而加强自护行为。     

心理干预对国内慢性乙型肝炎患者焦虑抑郁情绪影响的荟萃分析

目的:从循证医学角度探讨慢性乙型肝炎患者心理干预的可能性及必要性.方法:应用Meta分析的方法比较心理干预组和非干预分组在SCL-90(焦虑评分)、SCL-90(抑郁评分)、Zung焦虑自评量表(SAS)评分及Zung抑郁自评量表(SDS)评分方面的差异, 以加权平均数(WMD)为效应量进行合并分析.结果: 上述研究指标纳入研究文献合并效应量及95%可信限(95%CI)分别为-0.52(95% CI: -0.56, -0.47)、-0.79(95% CI: -0.83, -0.75)、-1.08(95% CI: -1.45, -0.71)和-0.79(95% CI: -0.83, -0.75). 结论:心理干预可以显著改善慢性乙型肝炎患者焦虑抑郁情绪, 增加治疗的依从性.     

老年人心理弹性、领悟社会支持与抑郁的结构方程模型

目的 考察老年人心理弹性、领悟社会支持与抑郁之间关系.方法 采用自我心理弹性量表(ERS)、领悟社会支持量表(PSSS)和自评抑郁量表(SDS)对天津市297名社区老年人相关心理特征进行调查,采用相关分析、回归分析和结构方程建模的方法分析老年人心理弹性、领悟社会支持与抑郁的关系.结果 老年人的心理弹性对抑郁有显著的负向预测作用(γ=-0.63)；老年人的领悟社会支持可以增强其心理弹性(γ=0.72),进而降低其罹患抑郁的风险；二者对老年人抑郁症状的方差解释率为40％.结论 心理弹性和领悟社会支持是老年抑郁的重要保护因素.     

个体社会资本在老年胃食管反流患者积极心理资本与适应性情绪的中介作用

背景胃食管反流病(gastroesophageal re?ux disease, GERD)是老年常见消化系统疾病之一,严重困扰患者生活质量,增加焦虑、抑郁等情绪.本研究旨在探讨老年GERD患者个体社会资本、积极心理资本、情绪表达之间的作用,为临床采取积极措施提高患者个体社会资本提供参考依据.目的探讨个体社会资本在老年GERD患者积极心理资本与适应性情绪表达的中介作用.方法采用抽样便利法,选取2018-02/2019-12在我院就诊治疗的老年GERD患者136例.采用个体社会资本测量问卷、积极心理资本量表和情绪表达量表进行调查.结果老年GERD患者个体社会资本得分19.87分±3.46分;积极心理资本得分124.36分±16.58分;抑制性情绪表达得分17.58分±3.76分,适应性情绪表达得分19.96分±3.83分,过度性情绪表达得分9.65分±2.85分.老年GERD患者个体社会资本与积极心理资本、适应性情绪表达呈正相关(r=0.269、0.245, P0.05),积极心理资本与适应性情绪表达呈正相关(r=0.365,P 0.05).采用结构方程模型,以个体社会资本为自变量,以积极心理资本、适应性情绪表达为中介变量,探讨两种变量共同作用的结构方程,结果表明,模型各项拟合良好.采用Bootstrap法进行多重中介效应检验.结果表明,间接效应1表明积极心理资本具有中介效应,占总中介效应的82.67%;间接效应2估计效应值为0.456,表明适应性情绪表达具有中介效应,占总中介效应12.05%;间接效应3估计效应值为0.184,表明链式中介效应,占总中介效应4.68%.对不同中介效应进行相互比较,结果表明,比较1说明积极心理资本的特定中介效应显著高于适应性情绪表达的特定中介效应(P0.05);比较2与比较3表明链式中介效应与积极心理资本的特定中介效应及适应性情绪表达的特定中介效应之间无统计学差异(P0.05).结论个体社会资本在老年GERD患者的积极心理资本与适应性情绪表达具有中介作用.在临床工作中医护人员可通过提高老年GERD患者的个体社会资本水平,提高患者积极心理资本和增强适应性的情绪表达.     

失能老年人照料者抑郁情绪的二因素模型

目的结合照料者心理健康二因素模型和自我效能感探究照料者抑郁情绪产生途径。方法使用自编人口学问卷、功能独立性评定量表、社会支持问卷、修订版负担指数量表、一般自我效能感量表、流调中心抑郁量表对185名失能老年人照料者进行调查。结果 (1)照料者抑郁程度与被照料者年龄,照料者负担指数,社会支持水平、和自我效能感水平显著相关;(2)照料者的自我效能感在其社会支持和抑郁情绪间起到部分中介作用;(3)照料者的负担指数在被照料者功能独立性和照料者抑郁情绪之间起到完全中介的作用。结论照料者抑郁情绪受到积极消极因素的共同影响,且照料者自我效能感在抑郁产生过程起中介作用。     

心理弹性在老年胃食管反流病患者抑郁水平与睡眠障碍间的中介作用分析

背景胃食管反流病(gastroesophageal reflux disease, GERD)是消化系统常见疾病之一,烧心、反流症状的反复发作将严重影响患者生活质量,并增加负面情绪.随着有益健康模型的提出心理弹性已备受临床医护人员的关注和重视.目的旨在探讨心理弹性在老年GERD患者抑郁水平与睡眠障碍间的中介作用.方法采用便利抽样法,选择2018-06/2019-12在浙江省金华市第二医院住院治疗的老年GERD患者120例为研究对象,使用睡眠质量指数量表、心理弹性量表和流调中心抑郁量表进行调查,运用SPSS 23.0分析数据,采用回归分析与Bootstrap法进行数据统计分析.结果老年GERD患者睡眠质量指数得分为6.57分±2.92分;心理弹性得分为52.04分±7.58分;抑郁得分为18.39分±4.15分.通过Pearson相关分析表明,老年GERD患者心理弹性与睡眠质量指数显著负相关(r=-0.272, P 0.01),抑郁水平与睡眠质量指数呈正相关(r=0.179, P 0.01),抑郁水平与心理弹性呈显著负相关(r=-0.251, P 0.01).采用多元回归分析法,以抑郁水平为因变量,以不同人口学特征为自变量建立模型1,引入睡眠质量指数建立模型2,引入心理弹性建立模型3,睡眠质量指数和心理弹性对抑郁水平分别有正向预测作用和负向预测作用.在多元线性回归分析的基础上,采用的Bootstrap法进行检验表明,心理弹性在睡眠质量与抑郁水平间的中介效应分析.结论心理弹性在老年GERD患者抑郁水平与睡眠障碍间具有中介作用,在临床工作中关注老年GERD患者睡眠质量和心理弹性水平并制定合理的干预措施,对促进老年GERD患者心理健康有重要意义.     

空巢老人心理弹性与焦虑抑郁情绪、主观幸福感的相关性

目的探讨空巢老人心理弹性与焦虑抑郁情绪、主观幸福感(SWB)的相关性。方法使用自编空巢老人一般资料调查表、Connor和Davidson心理弹性量表(CD-RISC)中文版、Zung焦虑自评量表(SAS)、老年人抑郁量表(GDS)和纽芬兰纪念大学幸福度量表(MUNSH)对250名空巢老人进行入户调查。结果心理弹性高分组的焦虑、抑郁的得分低于心理弹性低分组(P0.01),心理弹性高分组SWB得分高于心理弹性低分组(P0.01);心理弹性与焦虑、抑郁呈显著负相关(P0.01),心理弹性与SWB呈显著正相关(P0.01)。在多元线性回归中,抑郁(β=-0.805)、SWB(β=0.395)进入回归方程(F=46.754,P=0.000)。结论空巢老人心理弹性水平较低,与焦虑抑郁情绪、SWB密切相关。     

道家人格在缓冲老年人负性情绪中的中介作用

目的考察道家人格在缓冲老年人负性情绪中的中介作用。方法采用生活事件量表、道家人格量表、特质焦虑和抑郁简式量表对237名老年人进行调查,通过路径分析法对结果进行分析。结果静、躁维及联系、矛盾维的中介效应约占总效应的50%,自然、柔韧、谦退、超脱和寡欲约占总效应的8%。道家人格多个维度对焦虑的中介作用强过对抑郁的中介作用。二阶因素"真"的各个子维度起到了正性缓冲的中介作用,二阶因素"伪"的各个子维度起到了负性加剧的中介作用。结论道家人格多个维度在生活事件与负性情绪间具有部分中介作用。     

深圳地区HIV-1感染人群焦虑和抑郁患病状况及相关因素

目的了解目前深圳地区艾滋病病毒(HIV)感染人群焦虑和抑郁的患病情况,初步探索影响焦虑和抑郁的相关因素。方法 2016年1-3月对深圳市第三人民医院艾滋病门诊就诊的594例HIV感染者开展横断面研究,通过医院焦虑抑郁量表调查研究对象焦虑和抑郁的患病情况,并用SPSS软件分析相关的影响因素。结果594例患者中有焦虑症状者233例(39.2%),抑郁症状者240例(40.4%)。多因素分析显示,离异或丧偶[比值比(OR)=2.11,95%可信区间(CI):1.13~3.93]是焦虑产生的危险因素,抗病毒治疗(OR=0.66,95%CI:0.47~0.94)是保护因素;对于抑郁的形成,高中及以上文化程度(OR=0.58,95%CI:0.39~0.88)、家庭或社会支持(OR=0.44,95%CI:0.31~0.62)是保护性因素。结论深圳地区HIV感染者焦虑和抑郁的患病率较高,应该引起临床医生关注。对于新发现的HIV感染者应当进行常规心理健康问题的筛查,早期给予社会支持和心理关怀。     

The distressed (type D) personality is independently associated with impaired health status and increased depressive symptoms in chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a serious condition that is associated with impaired health status and a high prevalence of depressive symptoms. To date, little is known about the determinants of health status and depressive symptoms in CHF. Therefore, the aim of this study was to assess whether Type D personality is associated with impaired health status and increased depressive symptoms in heart failure patients, independent of disease characteristics. METHODS: Eighty-four patients (63 men and 21 women, mean age=65.9+/-12.1 years) with systolic CHF completed four questionnaires to assess Type D personality (14-item Type D Personality Scale [DS14]), health status (Minnesota Living with Heart Failure Questionnaire [MLWHFQ]), depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and mood status (Global Mood Scale [GMS]) when visiting an outpatient heart failure clinic. Information on clinical variables was obtained from patients' medical records. RESULTS: Type D patients were more likely to experience impairment in health status (18/38=47%) as compared to non-Type Ds (11/46=24%), P=0.027. They also more often reported symptoms of depression; namely 18 of 38=47% versus 6 of 46=13%, P=0.001. When controlling for severity and etiology of CHF, age and gender, Type D remained a significant associate of impaired health status [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.12-7.78] and depressive symptoms (OR 6.3, 95% CI 2.08-19.12). CONCLUSIONS: Type D was associated with impaired health status and increased depressive symptoms in CHF patients. These preliminary findings demonstrate the value of including personality factors in CHF research.     

Clustering of psychosocial risk factors enhances the risk of depressive symptoms 12-months post percutaneous coronary intervention.

BACKGROUND: Psychosocial risk factors cluster together, but generally a single factor approach has been adopted when studying their influence on health outcomes in cardiac patients. We examined the impact of clustering (i.e. type D personality and anxiety) on depressive symptoms 12 months post percutaneous coronary intervention (PCI). DESIGN: Prospective study. METHODS: Consecutive patients (n=416), treated with PCI with drug-eluting stents, completed the type D Scale and the Hospital Anxiety and Depression Scale anxiety subscale at baseline, and the depression subscale at 12 months. RESULTS: Of all patients, 27% experienced depressive symptoms at 12 months. Depressive symptoms could not be attributed to cardiac events occurring during follow-up (P=0.76). The prevalence of depressive symptoms at 12 months was highest in patients with clustering (64%), followed by the single risk factors type D (45%) and anxiety (38%), with the lowest prevalence in the no risk factor group (neither anxiety nor type D) (13%; P<0.001). The single risk factors type D personality [odds ratio (OR): 5.82; 95% confidence interval (CI): 2.93-11.56] and anxiety (OR: 4.36; 95% CI: 2.23-8.55) and their co-occurrence (OR: 12.38; 95% CI: 6.11-25.09) remained independent significant predictors of depressive symptoms at 12 months compared with the no risk factor group, adjusting for baseline characteristics. CONCLUSION: Patients with the co-occurrence of type D personality and anxiety, two risk factors independently associated with adverse prognosis, had a considerably higher risk of depressive symptoms 12 months post PCI compared with patients with no or one risk factor. Further research is warranted to examine whether clustering of psychosocial risk factors also has deleterious effects on prognosis.     

Prediction of functional disability by depressive state among community‐dwelling elderly in Japan: A prospective cohort study

Aim: We carried out a prospective cohort study to evaluate the risk factors of functional disability by depressive state. Methods: A total of 783 men and women, aged 70 years and over, participated in this study. We followed the participants in terms of the onset of functional disability by using a public long‐term care insurance database. The Geriatric Depression Scale (GDS) was used to measure depressive state. Age, sex, history of chronic disease, living alone, fall experience, cognitive impairment, instrumental activities of daily living (IADL), the Motor Fitness Scale (MFS), frequency of going out and social support at baseline were used as the main covariates. The Cox regression analysis was used to examine the difference in functional disability stratified according to depressive state. Results: The incidence of functional disability was 38 persons in the non‐depression group and 42 persons in the depression group (RR 2.34; 95% CI 1.46–3.79). The results of the depression group showed a significant difference in cognitive impairment (HR 3.51; 95% CI 1.39–8.85), MFS (HR 5.60; 95% CI 1.32–23.81) and IADL (HR 3.37; 95% CI 1.65–6.85). The results of the non‐depression group showed a significant difference in MFS (HR 2.97; 95% CI 1.47–6.96), and frequency of going out (HR 3.21; 95% CI 1.47–6.96). Conclusions: In conclusion, risk factors for functional disability were found to differ on the basis of whether or not community‐dwelling elderly individuals experience depressive state. The type of support offered must be based on whether or not depressive state is present. Geriatr Gerontol Int 2012; ??: ??–?? .     

Relation of symptomatic heart failure and psychological status to persistent depression in patients with implantable cardioverter-defibrillator

Studies on psychological morbidity in patients with an implantable cardioverter-defibrillator (ICD) have focused on mean differences rather than intraindividual differences. Such an approach masks the chronicity of symptoms in individual patients and the potential differences in cardiac outcomes. We examined the prevalence and correlates of persistent depression using an intraindividual approach. Consecutive patients who had undergone ICD implantation (n = 386; 79.3% men) completed a set of validated questionnaires, including the Hospital Anxiety and Depression Scale (HADS), at baseline and 3 months after implantation. Information on ICD therapies was obtained by device interrogation. At 3 months after implantation, 52 (14%) of the 386 patients had persistent depression (HADS cutoff ≥8 before and 3 months after implantation). Heart failure (odds ratio [OR] 2.29; 95% confidence interval [CI] 1.26 to 4.15), cardiac resynchronization therapy (OR 1.92; 95% CI 1.05 to 3.52), New York Heart Association class III-IV (OR 2.47; 95% CI 1.36 to 4.48), diabetes (OR 2.09; 95% CI 1.01 to 4.29), Type D personality (OR 8.30; 95% CI 4.42 to 15.58), high levels of ICD concerns (OR 2.60; 95% CI 1.44 to 1.71), diuretics (OR 2.41; 95% CI 1.26 to 4.61), and psychotropic medication (OR 3.58; 95% CI 1.86 to 6.90) were all significant univariate correlates of persistent depression at 3 months. No effect was found for ICD shock during follow-up (OR 1.59; 95% CI 0.57 to 4.41). In adjusted analysis, New York Heart Association class III-IV (OR 2.95; 95% CI 1.47 to 5.89), Type D personality (OR 7.98; 95% CI 3.98 to 16.04), and the use of psychotropic medication (OR 2.73; 95% CI 1.27 to 5.84) were independent correlates of persistent depression. In conclusion, symptomatic heart failure, psychological status, and psychotropic medication use predicted persistent depression after ICD implantation.     

Resilience associated with mental health problems among methadone maintenance treatment patients in Guangzhou,China

A considerable proportion of methadone maintenance treatment (MMT) clients have experienced mental health problems (e.g., depression and anxiety), and poor mental health status is associated with HIV-related risk behaviors and treatment drop-out. Resilience is known to be a protective factor for mental health problems but is not studied among MMT clients in China. This study aimed to explore the relationship between resilience and mental health problems (depression, anxiety and stress) among clients of community-based MMT clinics in China. A total of 208 MMT clients completed the face-to-face interview conducted at 4 of 11 MMT clinics in Guangzhou. The Chinese short version of Depression Anxiety Stress Scale (DASS-21) was used to assess the presence of depressive, anxiety and stress symptoms, and the Connor–Davidson Resilience Scale (CD-RISC) was used to measure resilience. Logistic regression models were fit in data analyses. Of all participants, 12.8%, 19.5% and 8.3% had depression, anxiety and stress, respectively. The mean resilience score was 57.6 (SD?=?15.9). In the univariate analyses, resilience was negatively associated with two studied mental health problems (depression and anxiety, OR_u?=?0.96 and 0.96, p?a?=?0.97, 95% CI: 0.93–0.99) and anxiety (OR_a?=?0.96, 95% CI: 0.94–0.99). Resilience was independently associated with depression and anxiety. As resilience is changeable, interventions targeting mental health problems of MMT users should consider resilience as an important part in the designing of such interventions.     

Leisure activity, mobility limitation and stress as modifiable risk factors for depressive symptoms in the elderly: results of a national longitudinal study

Few national longitudinal studies have investigated the modifiable risk factors for depression in the elderly. This study investigated the risk factors and health-related behaviors associated with depressive symptoms using a national survey of Taiwanese elderly with a 4-year follow-up period. In this prospective cohort study, 1481 non-demented population-based elderly were interviewed at baseline in 2003 and at follow-up in 2007. The independent variables included demographics, chronic medical diseases and health-related behaviors assessed at baseline. The dependent variable was depressive symptoms assessed at follow-up. Reduced rank regression was applied to characterize independent factors related to depressive symptoms. The prevalence of depressive symptoms at follow-up was 21.1%. The results of multivariate analyses revealed three independent risk factors for depressive symptoms: fewer leisure activities (odds ratio, OR=0.56, 95% confidence interval, CI=0.38-0.83, p=0.0034), more mobility limitations (OR=1.93, 95% CI=1.30-2.86, p=0.0011) and higher stress levels (OR=2.43, 95% CI=1.68-3.50, p<0.0001). The leisure activities least associated with depression were reading newspapers/books and doing outdoor building projects; the two mobility limitations most associated with depression were difficulty in lifting things and in climbing stairs. The two stresses most associated with depression were perceived health stress and financial stress. These results indicated that interventions to prevent or reduce depression in older adults should include practical strategies aimed at these modifiable risk factors.     

自我效能在老年功能性消化不良患者社会支持和健康促进生活方式间的中介作用

背景自我效能和社会支持均能影响患者健康问题.目前对老年功能性消化不良(functional dyspepsia, FD)患者从自我效能和社会支持角度探索研究较少.因此本研究探讨老年FD患者的自我效能在社会支持,健康促进生活方式间的中介作用,为今后临床开展促进老年FD患者健康水平工作提供客观依据.目的探讨自我效能在老年FD患者社会支持和健康促进生活方式间的中介作用.方法选择2018-10/2019-10在浙江省金华市第二医院住院治疗的老年FD患者162例,采用一般自我效能问卷,社会支持量表及健康促进生活方式量表进行调查.结果老年FD患者社会支持总分为37.65分±6.58分,处于中度水平;一般自我效能感量表总分为27.62分±5.48分,属于中度水平;健康促进生活方式量表总分为120.85分±20.73分,处于一般水平.通过Pearson相关性分析表明,老年FD患者健康促进生活方式,社会支持及自我效能均呈正相关(P<0.05),社会支持总分,客观支持维度与一般自我效能呈正相关(P<0.01).以自我效能感作中介变量,社会支持作自变量,健康促进生活方式作因变量进行分层回归分析.中介效应估计值为0.458×0.384=0.175,占总效应之比为(0.458×0.384)/(0.458×0.384+0.431)=28.87%.结果表明,标准化回归系数均达显著水平(P<0.01),说明自我效能在老年FD患者社会支持和健康促进间具有中介作用.在多元线性回归分析基础上,采用非参百分位检验取样方法,取95%的置信区间使用Bootstrap法对自我效能感的中介效应进行检验,结果表明,自我效能感中介效应的95%的置信区间为0.115-0.223,P <0.05,说明自我效能感在社会支持和健康促进生活方式间起中介作用.结论老年FD患者社会支持,自我效能以及健康促进生活方式处于中等或一般水平;自我效能在社会支持与健康促进间起部分中介作用.所以,在临床工作中医护人员要加强老年FD患者的社会支持,提高患者自我效能,从而提升健康促进生活方式水平,改善患者健康情况.     

Social support and family functioning on psychological symptoms in elderly Chinese

The purpose of this study was to extend our knowledge about how social support and family functioning affect mental health, and to examine the buffering effects of support in the presence of health stressors. A random cluster sample of 507 elderly community people were surveyed with a structured questionnaire, which included the depression and anxiety subscale of the Chinese version of Symptom Checklist 90-R (SCL-90-R), Social Support Rating Scale (SSRS), Family Emotional Involvement and Criticism Scale (FEICS), Short Portable Mental Status Questionnaire (SPMSQ), and the Katz Activities of Daily Living Scale (KADL). Results revealed that women had more anxiety symptoms than men (mean=3.49; 95% CI: 3.02-3.95 versus mean=2.56; 95% CI: 2.27-2.85). Emotional support was more important than instrumental support for psychological symptoms. Family emotional involvement was inversely correlated to depression (r=-0.19) and anxiety (r=-0.22), while criticism was positively correlated to depression (r=0.29) and anxiety (r=0.31). Multivariate analysis revealed that women, impaired cognitive function, urban residents with chronic diseases, less emotional support, and more criticism from the family were associated with more depressive and anxiety symptoms. Family involvement had buffering effects on psychological symptoms for people with cognitive impairment and medical diseases. Our results imply that elderly people with mental symptoms and chronic medical diseases benefit more from family involvement.