影响抑郁症出院病人抑郁程度的多因素分析

目的探讨生活事件、自动思维、社会支持与应付方式对抑郁症出院病人抑郁严重程度的影响。方法对97例抑郁症患者在其出院时进行测评,测评工具包括自评抑郁量表(Self-Rating DepressionScale,SDS)、生活事件量表、社会支持量表、自动思维问卷和应付方式问卷,此外对100例正常对照亦进行上述测评。结果与正常对照组相比,抑郁症患者经历的应激性生活事件较多(131.4±105.2/103.0±93.3,t=2.0,P<0.05),得到较多的总社会支持(40.8±8.0/38.2±8.5,t=2.3,P<0.05)、客观和主观社会支持(t=2.1、3.0,P<0.05),较少采用幻想、求助、合理化、解决问题等应付方式(t=-3.3、-2.1、-2.6、-5.3,P<0.05)。logistic回归分析显示生活事件、自动思维、幻想、自责、解决问题五个指标对抑郁严重程度的影响有显著性。进一步路径分析表明,自动思维、自责、解决问题对抑郁程度有直接影响,自动思维对SDS的直接影响最大(路径系数为0.474,P<0.01),自责、解决问题为其次(路径系数分别为0.237、-0.150,P<0.01),而生活事件、幻想对抑郁严重程度的影响是间接的。结论生活事件、自动思维、幻想、自责、解决问题五个指标对出院病人抑郁严重程度的影响有显著性。

A Multi-Factorial Analysis on the Severity of Depression in Major Depression at Discharge

Objective: To explore the effects of life events, automatic thoughts, social support and coping styles on the severity of depression in major depression at discharge. Methods: A cohort of 97 major depressed in-patients was assessed at discharge. The assessment included Self-Rating Depression Scale (SDS), Life Events Scale, Social Support Scale, Automatic Thoughts Questionnaire and Coping Styles Questionnaire. 100 normal controls were assessed, too.Results: Compared with the controls, the patients experienced more stressful life events in the last one year(t=2.6,P<0.05), got more global, objective and subjective social support(t=2.1,3.0,P<0.05), and applied less coping styles such as fancy, self-blame, rationalization and problem-solving(t=-3.3,-2.1,-2.6,-5.3,P<0.05). Life events, automatic thoughts, fancy, self-blame and problem-solving played a significant role in major depression by using Logistic regression analysis. Path-analysis showed that automatic thoughts, self-blame and problem-solving had significant direct effects on the severity of depression, and the path coefficients were 0.474, 0.237 and-0.150, P<0.01,respectively. While the role of life events and fancy was indirect.Conclusions: Life events, automatic thoughts, fancy, self-blame and problem-solving played a significant role in major depression at discharge.