肿瘤化疗患者的焦虑抑郁与社会支持、应对方式的关系及对疗效的交互作用研究

目的 研究肿瘤化疗患者的焦虑抑郁与社会支持、应对方式的关系及对疗效的交互作用。方法 选取2016年8月至2019年8月的肿瘤科住院化疗500例患者，统计患者一般资料，发放焦虑自评量表（SAS）、抑郁自评量表（SDS）、社会支持评定表（SRRS）、医学应对问卷（MCMQ），依次评估患者焦虑、抑郁、社会支持、应对方式，统计问卷回收率、焦虑与抑郁发生率，并对一般资料进行单因素分析，以logistic多元回归方程分析影响焦虑、抑郁发生的因素，采用Pearson分析SAS、SDS评分与SRRS、MCMQ评分的相关性，通过分层分析及相对超危险度比（RERI）、交互作用指数（S）、归因比（AP）评价焦虑、抑郁对疗效的交互作用。结果 入组患者中250例有焦虑，142例有抑郁；大专及以上文化程度（OR=0.897、0.417）、确诊时肿瘤T分期Ⅰ期（OR=0.404、0.435）、临床缓解（OR=0.677、0.827）是焦虑、抑郁发生的相关保护因素，自费（OR=2.080）、化疗疗程＞6个（OR=2.974）、无费用承担能力（OR=3.598）、KPS评分≤70分（OR=2.165）、睡眠时间≤7 h/d（OR=2.461）是焦虑发生的相关危险因素，无费用承担能力（OR=1.488）是抑郁发生的相关危险因素（P＜0.05）；SAS、SDS评分均与SRRS（r=-0.561、-0.384）、MCMQ-面对评分（r=-0.665、-0.505）呈负相关，均与MCMQ-屈服（r=0.656、0.550）、MCMQ-回避评分（r=0.518、0.412）呈正相关（P＜0.05）；交互作用分析显示，S=1.16，RERI=0.74，AP=0.12。结论 肿瘤化疗患者焦虑、抑郁情绪受文化程度、确诊时肿瘤T分期等多种因素的影响，并与社会支持、应对方式显著相关，且对疗效具有正向交互影响。

The relationship between anxiety and depression,social support,coping style and interaction of curative effect in patients with tumor chemotherapy

Objective To study the relationship between anxiety and depression, social support, coping style in patients with cancer chemotherapy, and its interaction with curative effect. Methods A total of 500 patients with oncology inpatients from August 2016 to August 2019 were selected. General information of patients were collected. The patients’ anxiety, depression, social support, and coping style were evaluated using anxiety self-assessment scale(SAS), depression self-assessment scale(SDS), social support assessment form(SRRS), medical response questionnaire(MCMQ)in turn. The questionnaire recovery rate, anxiety, and depression incidence were counted, a single factor analysis was performed on the general data, and the factors affecting the occurrence of anxiety and depression were analyzed using Logistic multiple regression equations. Pearson analysis was used to analyze the correlation between SAS and SDS scores and SRRS and MCMQ scores, and the interactive effects of anxiety and depression on curative effect were evaluated by stratified analysis and relative super risk ratio(RERI), interaction index(S), and attribution ratio(AP). Results Among the enrolled patients, 250 had anxiety and 142 had depression. College degree or above(OR=0.897, 0.417), T stage I of the tumor at the time of diagnosis(OR=0.404, 0.435), clinical remission(OR=0.677, 0.827) were related protective factors for anxiety and depression, while self-funded(OR=2.080), chemotherapy course>6(OR=2.974), no cost-bearing ability(OR=3.598), KPS score ≤70 points(OR=2.165), sleep time ≤7 h/d(OR=2.461) were related risk factors for anxiety.No cost-bearing ability was a related risk factor for depression(P<0.05). SAS and SDS scores were negatively correlated with SRRS(r=-0.561,-0.384), MCMQ-face scores(r=-0.665,-0.505), and were positively correlated with MCMQ-yield(r=0.656, 0.550) and MCMQ-avoidance scores(r=0.518, 0.412)(P<0.05). Interaction analysis showed that S=1.16, RERI=0.74, and AP=0.12. Conclusion The anxiety and depression of patients with tumor chemotherapy are affected by many factors such as education level and tumor T stage at diagnosis. They are significantly related to social support and coping style, and have positive interaction effects on curative effect.