Ⅱ型糖尿病患者心理卫生社区干预效果与影响因素分析

目的：探讨糖尿病社区干预措施对Ⅱ型糖尿病患者心理卫生状况干预的有效性及其影响因素，为适宜的社区干预对策与措施的制定提供科学依据。方法：按群体实验流行病学方法，选取山东省两城市社区分别作为干预社区与对照社区。1997年，收集基线资料，同时开始在干预社区实施糖尿病综合干预措施。2001年，再次以相同的方法收集两社区相关资料，通过两社区基线与4年后资料的比较，分析社区干预对Ⅱ型糖尿病患者焦虑总标准分、抑郁指数和社会支持分的影响。并通过对干预社区干预后的病例对照分析，探讨上述心理卫生指标与Ⅱ型糖尿病的关系及其影响因素。结果：4年后，干预社区患者的焦虑总标准分、抑郁严重度指数和社会支持总分及主、客观支持分各指标均有显著性改善，而对照社区患者各项指标的改变无统计学意义。干预后干预社区患者各心理卫生指标仍与一般健康人群有显著性差异。排除了年龄、性别、职业等因素的潜在混杂作用后，焦虑总标准分、抑郁严重度指数及客观支持总分仍与Ⅱ型糖尿病有显著关联，0R值分别为1．41，1．79，0．69。多元逐步回归分析显示，文化程度越高患者的心理卫生健康状况越好，而同时患其它慢性病则为影响患者心理卫生健康的危险因素。结论：该社区水平的糖尿病干预项目对Ⅱ型糖尿病患者的心理卫生状况有显著改善作用，但仍未有效解决患者的心理卫生问题。干预后，文化程度和患其它慢性病是Ⅱ型糖尿病患者心理卫生状况的主要影响因素。在糖尿病社区干预项目中应有针对性地加强心理卫生干预的有关内容。

Community Intervention on Mental Health of Patients with Type 2 Diabetes Mellitus

Objective: To study the effect of community intervention on mental health of patients with type 2 diabetes mellitus (DM) Method:Two communities in a city of Shandong province were chosen as intervention community and control community respectively after an epidemiological investigation of diabetes mellitus in 1997 After four years intervention, a case-control study was done by assessing mental status with SAS (self-rating anxiety scale), SDS (self-rating depression scale) and SSRS (social support rating scale) Result:Compared with baseline levels, after intervention for 4 years, the SAS score, SDS score and SSRS score (including subject score and object score) of patients in intervention community improved significantly, while the counterparts of patients in control community had no improvement But patients in intervention community still had poorer results than health controls By adjustment of the potential confounding effect of age, sex and occupations, diabetes mellitus still had influence on anxiety, depression and social support with ORs of 1 41, 1 69 and 0 69 respectively Multivariable stepwise analysis showed that, suffering from other chronic diseases was risk factor for mental health of diabetes patients, and the higher the education level, the better results of intervention Conclusion:The DM community intervention program improves mental health of patients significantly, but patients still have poorer mental health than healthy control Education level and suffering from other chronic disease are main factors having influence on effects of the intervention