【作者】 窦学俊；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2010， 博士

【副题名】愤怒郁怒者的机体状态、个性特点及其与情志病证关系的流行病学调研

【摘要】 目的：在七情中怒与肝关系最为密切,怒是对人们心身健康和人际关系影响最大的负性情绪之一。已有研究对于怒的表达方式及其致病条件涉及较少,且定性描述多定量分析少,对愤怒、郁怒两种不同类型的研究更少。因此,本研究选择代表性职业人群,以斯氏量表区分受调查者愤怒与郁怒,以公认量表测量相关的心理、生理状态,同时调查愤怒郁怒相关情志病证患病情况。通过分析上述因素间的内在联系,探索愤怒郁怒诱发情志病证的致病条件,为深入研究情志致病复杂机制,尤其是致病条件,提供基础资料和初步的理论依据。方法：运用流行病学横断面调查方法对大学生、护士、工人群体共3049人进行问卷调查。使用状态-特质怒表达量表Ⅱ(STAXI-2)对个体进行愤怒(anger-out)、郁怒(anger-in)表达方式判别,采用匹兹堡睡眠质量调查表(PSQI)和疲劳评定量表(FAI)评价个体睡眠和疲劳状况,用艾森克人格问卷(EPQ)评定个性特质,用一般情况问卷调查情志病证患病情况。分析各职业人群怒表达方式与睡眠疲劳状况、个性及情志病证的相关性。结果：在怒表达方式上,大学生中男生郁怒发生率低于女生、愤怒发生率高于女生；护士按学历分布有显著差异；工人中有性别、学历分布差异。怒表达不同组别间EPQ人格维度分析显示,郁怒组四个维度与非愤怒郁怒组间均有显著差异,愤怒组除内外向维度外均有著差异,愤怒组有胆汁质特征,郁怒组有抑郁质特征。说明在当今社会环境下,人们愤怒或郁怒的的表达方式受职业、性别、学历等外部因素影响,同时也有内在稳定性。睡眠质量调查显示,PSQL总分在愤怒郁怒分组间有差异,大学生郁怒组最高,愤怒组次之；护士、工人愤怒组最高,郁怒组次之。疲劳状况调查显示,疲劳在愤怒郁怒分组间有差异,大学生、工人愤怒组疲劳发生率最高,护士郁怒组最高；重度、中度、一般程度疲劳发生率,三个人群均以护士为最高,工人次之,学生最低。说明睡眠、疲劳等机体状态受愤怒、郁怒和职业因素的影响。进一步分析显示,睡眠、疲劳、个性量表的不同成分、因子或维度及相关病证对愤怒、郁怒又有不同影响：大学生群体中,PSQL总分、疲劳的环境特异性、失眠、胃肠病等因素与郁怒呈正相关,神经质、习惯睡眠效应、疲劳对休息或睡眠的反应呈现负相关；年级、日间功能障碍、疲劳的严重程度等因素与愤怒呈正相关,失眠、精神质、神经质、掩饰性为负相关。护士群体中神经质、疲劳的环境特异性与郁怒呈正相关,内外向、疲劳对休息或睡眠的反应呈负相关；年龄、精神质、神经质、睡眠习惯效应等变量与愤怒呈正相关,学历、掩饰性为负相关。工人性别、学历与郁怒呈正相关,内外向、神经质呈负相关；婚况、神经质、精神质、睡眠障碍、高血压、胃肠病等变量与愤怒呈正相关,掩饰性、习惯睡眠效应呈现负相关。情志病证总发病率与胃肠病、PMS与其他病证发生率愤怒组高于郁怒组,两组均高于非愤怒郁怒组,说明愤怒、郁怒对情志病证有重要影响且愤怒影响更大。情志病证患病组和未患病组间睡眠障碍和疲劳状况分别存在显著差异；在未患病组、患病组和总体人群中,睡眠障碍与疲劳均有正相关关系。说明机体状态与情志病证有显著相关性,且睡眠障碍与疲劳有内在联系。年龄、性别、学历、精神质、掩饰性、入睡时间、睡眠时间、日间功能障碍、疲劳的严重程度、疲劳对环境的特异性等变量与情志病证有较强联系,其中性别、掩饰性、疲劳对环境的特异性呈现负相关。上述结果提示愤怒、郁怒可以直接影响情志病证发病,也可能通过睡眠、疲劳状况影响情志病证。结论：怒产生机制、怒引发情志病证机制是多因素复杂作用过程,研究怒致病当区分愤怒和郁怒；愤怒郁怒表达方式受职业、性别、年龄、学历等外部因素影响又有内在稳定性；睡眠障碍、疲劳与愤怒、郁怒成正相关,睡眠、疲劳状态及个性特点是愤怒郁怒致病的重要条件,各因素以潜在的气血不畅为中介共同作用于从健康到情志病证的过程；愤怒、郁怒增加情志病证发病率,且愤怒影响更大。本研究揭示了三种人群愤怒郁怒致病过程中部分生理、心理因素及其相互关系,为愤怒郁怒情志致病条件研究提供了第一手流行病学调查数据,也提供了研究中应当关注的机体状态和个性特点等必要线索。更多还原

【Abstract】 Objective:Being most closely with the liver and the most intolerable negative emotion, anger is of greatest impact of physical and mental health and interpersonal in the seven emotions. But there was a lit of studies about produced for the anger and pathogenic conditions, and quantitative analysis studies are less than qualitative description ones. And the studies about two different types of anger which named anger-out and anger-in were fewer. Therefore, this study, use quantitative ways of separating anger-out and anger-in and sophisticated instrument to measure the relevant psychological and physiological state, and investigate emotional diseases related to anger in chosen representative professional groups. By analyzing the inherent relationships of the above factors, it may explore the pathogenic conditions for emotional diseases induced by anger-out and anger-in, and provide basic information and a preliminary theoretical basis for depth study of the complex mechanisms especial pathogenic conditions of emotional diseases.Methods:Total 3049 persons of different professions were investigated by epidemic cross-sectional survey method. Anger expression styles were distinguished by Spielberger State-Trait Anger Expression Index-2(STAXI-2). Body conditions were evaluated by using Pittsburg Sleep Quality Index(PSQI) and Fatigue Assessment Index(FAI). Eysenck Personality Questionnaire(EPQ) and questionnaire on general conditions were adopted to gather information of the traits of personality and emotional diseases. The relationships between anger-in, anger-out and individual sleep or fatigue condition, personality and emotional diseases were analyzed.Results:Boy students were apt to express anger-out and girl students were apt to express anger-in. The distribution of nurses by educational background was significantly different. There was different distribution of gender, educational levels in workers. EPQ personality dimensions analysis among different groups of anger expression shows that, compared with non-anger-in or anger-out group, there were significant differences in four dimensions in of anger-in group, and similarly except extroversion in anger-out group. And it also showed the anger-out group had trait of bilious temperament while the anger-in group of melancholic temperament. It was noted that in the current social environment, people’s expression of anger was affected by occupation, gender, education and other factors, and also had inherent stability.Sleep quality survey showed that the total scores of PSQI were different between groups. Anger-in was the highest, followed by anger-out group in students; in nurses and workers, anger-out the highest, followed by anger-in. Fatigue survey showed that angry-out group was the highest in students and workers, and anger-in group was the highest in nurses. For the incidence of severe, moderate and general level of fatigue, nurses were the highest in the three groups, followed by workers and students. It suggested that the body status such as sleep, fatigue were affected by the anger-out, anger-in and occupational factors.Further analysis showed that sleep, fatigue, personality scale of the different components, factors or dimensions and related diseases had different effects to anger-out and anger-in. In student group, insomnia, gastrointestinal disease, total score of PSQI, and fatigue-specific factors such as the environment were positively correlated with anger-in, and nervousness, sleep habits, effect of fatigue on rest or sleep showed negative correlation; grade, daytime dysfunction, severity of fatigue were positively correlated with anger-out, and insomnia, mental quality, Nervousness, Lie scores had negative correlation. In nurse group, Nervousness, fatigue, environmental specificity were positively correlated with anger-in, and Extroversion scores and the fatigue response of rest or sleep were negative correlation; age, mental quality, Nervousness, sleep habits were positively related to anger-out, and education background, Lie scores had negative correlation. In workers, gender, education background were positively correlated with anger-in, and Extroversion scores, Neuroticism were negatively correlated; marital status, hypertension, gastrointestinal diseases, Neuroticism, Psychoticism, sleep disorders were positively related to anger-out, and Lie scores, effects of sleep-related habits of the negative correlation.For the incidence rate of total emotional diseases and gastrointestinal diseases, PMS and other diseases, anger-out, anger-in and normal group in turn lower. And it described that the anger expression had important influence on emotional diseases and anger-out had greater impact. There were significant differences of distribution of sleep disorder and fatigue was between cases of emotional diseases and non-diseased. There was positive correlation between sleep disorder and fatigue either in group of emotional diseases and non-diseased or in whole subjects. Age, gender, education background, Psychoticism, Lie scores, sleep latency, sleep time, daytime dysfunction, fatigue severity, the specificity of fatigue on the environment had strong emotional ties to emotion diseases, in which gender, Lie scores, the specificity of fatigue on the environment was negative. These results suggested that anger-out and anger-in might affect the incidence of emotional diseases directly or through the conditions of sleep and fatigue.Conclusions:The mechanisms of anger and anger trigger emotional diseases were complex multi-factor effect processes, and anger-out and anger-in showed distinguished. The two anger expression styles were affected by external factors such as occupation, gender, age, education and also had inherent stability. Sleep disorders and fatigue were positively related to anger-in and anger-out, and sleep, fatigue and personality was an important condition for diseases induced by angry. The potential obstacle of Qi and blood was the medium in the process from health to emotional diseases. Anger-out and anger-in were risk factors to emotional diseases, and anger-out made a greater impact. This study revealed some of the pathogenesis of physical, psychological factors and their mutual relations for anger triggering emotional diseases, and provided epidemiological data on first-hand and necessary clues for the study of pathogenesis conditions of anger.更多还原