老年抑郁症恢复期患者的应对方式及社会支持的评价

背景:老年抑郁症表现以不典型抑郁多见,且患者很少就诊或在综合医院就诊,给老年抑郁症的早期识别带来很大困难。目的:探讨老年抑郁症恢复期患者的应对方式及社会支持的特点。设计:病例对照对比观察。单位:华北煤炭医学院心理系。对象:收集2004-11/2005-10于北京安定医院老年门诊就诊的抑郁症恢复期患者为抑郁症组。纳入标准:①发病年龄≥60岁;②符合DSM-Ⅳ抑郁发作的诊断标准;③处于疾病恢复期,老年抑郁量表(GDS)≤10;④受试者知情同意。排除标准:①其他因素导致的抑郁障碍如物质滥用导致的抑郁障碍、精神分裂症后抑郁等;②严重或不稳定的躯体疾病患者,如严重心脑血管病、肝肾疾病、癫痫、内分泌疾病等。发放问卷104份,96份问卷有效,入组患者中男37例,女59例;年龄60～87岁,平均(68±6)岁。病程为0.3～11年,平均1.2年。选择同期北京市某普通社区老年人作为对照组。纳入标准:①年龄≥60岁;②无精神障碍;③获得受试者知情同意。排除标准:同抑郁症组。正常老年人于社区居委会在培训员的协助下当日完成自评量表,发放问卷110份,100份问卷有效。入组受试者中男44名,女56名;年龄60～84岁,平均(67±5)岁。两组受试对象在性别、年龄、受教育程度、居住情况及婚姻情况方面的差异无统计学意义。方法:对96名抑郁症组老年抑郁症恢复期患者及100名对照组普通社区老年人使用自制一般情况调查表、老年抑郁量表、社会支持量表和简易应对方式问卷进行评定。主要观察指标:自制一般情况调查表、老年抑郁量表、社会支持量表和简易应对方式问卷的评分。结果:196名受试者均进入结果分析,没有无效问卷。抑郁组患者积极应对方式低于对照组(P<0.05),消极应对方式明显高于对照组(P<0.05)。抑郁组患者社会支持总分、主观支持和对支持的利用度低于对照组(P<0.05),两组受试对象客观支持分差异无显著性。抑郁组患者积极应对与社会支持总分、主观支持和对支持的利用度呈正相关(P<0.01),消极应对与社会支持总分、主观支持和对支持的利用度呈负相关(P<0.01)。结论:社会支持中的主观支持和对支持的利用度以及消极的应对方式与老年抑郁症发病有关。

Coping style and social support in senile depressive patients at convalescent stage

BACKGROUND: The clinical manifestation of senile depression is not typical. The patients with senile depression seldom visit in general hospital, which is hard for clinical doctors to identify the disease at early time.OBJECTIVE: To research the traits of Coping style and social support in the recovered senile depressive patients.DESIGN: Case-control observation.SETTING: Department of Psychology in North China Coal Medical College.PARTICIPANTS: Ninety-six senile depressive patients at convalescent stage were selected for depressive group in clinic service of Beijing Anding Hospital from November 2004 to October 2005. Inclusion criteria: ①Aged≥60 years old. ② Coded with depression with DSM-Ⅳ. ③ Being the period of recovery, geriatric depression scale(GDS)≤10. ④Informed consent was obtained from each participant. Exclusion criteria: ① Depression resulted from other factors for instance substance abuse and schizophrenia,etc. ②Serious and instable body disease such as cerebrovascular disease,liver and kidney disease, falling sickness, disease of internal secretion. Totally 104 questionnaires were sent out, and 96 were qualified. 37 were male and 59 were female in the depressive group, aged 60-87 years old,with average of (68±6)years. The course of disease was 0.3-11 years, with mean of 2 years. The elderly from ordinary community of Beijing were invited for control group. Inclusion criteria: ①Aged ≥ 60 years old; ② No mental disease. ③ Informed consent was obtained from each participant.Exclusion criteria: The same to the depressive group. There are 100 participants in the control group, 44 were male and 56 were female, aged 60 to 84 years old, with average (67±5) years old. There were no significant differences between depressive group and control group in gender, age, education, living conditions and marriage status.METHODS: 96 senile depressive patients at convalescent stage and 100healthy aged were investigated with self-made questionnaire, Geriatric Depression Scale (GDS), Social Support Rating Scale (SSRS) and Simplified Coping Style Questionnaire (SCSQ).MAIN OUTCOME MEASURES: The scores of the self-made questionnaire, GDS, SSRS and SCSQ answered by participants in each group.RESULTS: All the 196 participants entered the result analysis. There was not disqualified questionnaire. There were significantly lower scores of positive coping style and higher scores of negative coping style in the depressive group than the control group(P ＜ 0.05 ). There was lower score of social support, subjective social support and use of social support in the depressive group than the control group (P ＜ 0.05). The scores of objective social support was not significantly different in each group. There was remarkable positive correlation between active coping style and score of social support, subjective social support and use of social support in recovered senile depressive group (P ＜ 0.01). Passive coping style was negatively correlated with score of social support, subjective social support and use of social support(P ＜ 0.01 ).CONCLUSION: Subjective social support and use of social support and negative coping style are the major risk factor in the onset of senile depression.