【摘要】 目的:采用问卷调查法分析骨折住院患者的焦虑抑郁及其相关因素,为骨科临床心理干预提供依据。方法:于2003-05/2004-04选择大连医科大学附属第二医院骨科,大连市第二医院骨科,大连市第四医院骨科,解放军第二一○医院骨科的住院骨折患者200例为骨折组观察对象。对照组主要在大连医科大学中山学院工作人员、家属及学生中选取躯体功能健康者110人。采用自制的一般情况调查表获悉骨折患者的基本情况。焦虑状况评定采用焦虑自评量表,每项症状按1～4级评分,各项得分相加得总粗分,将总粗分乘以1.25即得标准分,50分为临界值。抑郁评定采用抑郁自评量表,每项症状按1～4级评分,各项得分相加得总粗分,将总粗分乘以1.25即得标准分,53分为临界值。人格评定采用成人艾森克人格问卷,共85题,分内外向、神经质、精神质和掩饰4个因子,直接对粗分进行比较分析。对来自各种社会资源如家庭、朋友和其他方面支持的感受程度的评定采用领悟社会支持量表,包括12个自评项目,采用1～7级计分法,以支持总分参加分析,分数越高领悟支持总程度越好。采用访谈式问卷调查。骨折组患者调查时间统一选在入院后3～7d内进行。对照组学生在测定期间无考试。结果数据进行t检验、χ2检验、秩和检验、Pearson相关分析、一元及多元线性回归分析。结果:骨折组发放问卷200份,收回合格问卷185份,有效率92.5%;对照组发放问卷110份,收回合格问卷101份,有效率91.8%。①骨折患者焦虑和抑郁的发生率分别为45.4%(84/185)和50.3%(93/185);对照组中分别仅有10.9%(11/101)、22.8%(23/101)存在焦虑、抑郁情绪,二者差异有高度显著性(P<0.01)。焦虑合并抑郁的发生率为33.5%(62/185);相关分析揭示焦虑与抑郁高度正相关(相关系数为0.605,P<0.01);焦虑、抑郁分别与神经质、精神质、住院费用、住院天数呈显著正相关(P<0.05),而与领悟社会支持、内外向、掩饰呈显著负相关(P<0.05)。骨折组焦虑、抑郁的标准分均值均高于对照组健康人群,差异有高度显著性(P<0.01)。②以骨折组焦虑与抑郁评分为因变量,年龄为自变量,进行一元线性回归分析。焦虑的一元线性回归方程为Y=41.441+0.161X;抑郁的一元线性回归方程为Y=42.966+0.169X。不同年龄骨折患者焦虑水平差异有显著性(F=10.886,P<0.01);不同年龄骨折患者抑郁水平差异有显著性(F=14.946,P<0.01);随着年龄的增加,焦虑、抑郁水平逐渐升高。③骨折组焦虑、抑郁评分为因变量,以骨折患者性别、年龄、婚姻、文化程度、职业、年经济收入、骨折部位、是否手术、伴随疾病、住院费用、住院天数、有无保险、人格(内外向、神经质、精神质和掩饰因子分)、领悟社会支持为自变量,行Backward线性逐步回归分析,结果显示在α=0.05水平上,有5个因素进入焦虑回归方程,依次是领悟支持程度、神经质、性别、住院天数、未婚;有6个因素进入抑郁回归方程,依次是神经质分、领悟支持程度、住院费用、未婚、伴随疾病、文化程度。结论:骨折住院患者焦虑、抑郁水平显著升高,且与多种因素相关。骨折患者焦虑的影响因素依次为:领悟社会支持、神经质性格、性别、住院天数和婚姻(未婚);抑郁的影响因素依次为:神经质性格、领悟社会支持、住院费用、婚姻(未婚)、伴随躯体疾病和文化程度。更多还原

【Abstract】 AIM: To analyze anxiety, depression and related factors in fracture inpatients by means of questionnaire investigation, so as to provide evidence for orthopedic clinical psychological intervention.METHODS: From May 2003 to April 2004, 200 inpatients with fracture were selected as objects from Department of Orthopedics, the Second Affiliated Hospital of Dalian Medical University, Department of Orthopedics of Dalian Second People’s Hospital Department of Orthopedics, Dalian Fourth People’s Hospital, and Department of Orthopedics of the 210 Hospital of Chinese PLA. Totally 110 healthy subjects were selected from personnel, relatives and students in Zhongshan college of Dalian Medical University as the control group. The general information of the inpatients were investigated with the self-designed general questionnaire. Anxiety was assessed with self-rating anxiety scale (SAS), consisted of 20 items, each symptom scored by 1 to 4 grades, each score add together to get the total crude score and the total crude score multiplied by 1.25 as the standard score, the value of delimitation was 50. Depression was assessed with self-rating depression scale (SDS), consisted of 20 items, each symptom scored by 1 to 4 grades, each score add together to get the total crude score and the total crude score multiplied by 1.25 as the standard score, the value of delimitation was 53. Personality was evaluated with adult Eysenck personality questionnaire (EPQ), consisted of 85 items and 4 factors including introversion and extraversion, neuroticism, psychoticism and conceal, the crude scores were compared directly. Degree of perceived social support came from various social sources, for example family, friends and others, was evaluated on perceived social support scale (PSSS), including 12 items, each item scored by 1 to 7 grades, analyzed by total support score, the higher the better. Inpatients with fracture were interviewed by questionnaire investigation, 3-7 days after admission; students in the control group had no exam in course of assessment. The t test, χ2 test, rank sum test, Pearson correlation analysis, simple and multiple linear regression analysis were applied.RESULTS: Totally 200 questionnaires and scales were sent out, and 185 of them were qualified, the effective rate was 92.5% in the facture group. Totally 110 questionnaires and scales were sent out, and 101 of them were qualified, the effective rate was 91.8% in the control group. ① The incidence rate of anxiety was 45.4% (84/185) and that of depression was 50.3% (93/185) in the fracture group, which were significantly different from those in the control group 10.9% (11/101); 22.8% (23/101) . The incidence rate of anxiety plus depression was 33.5% (62/185). Correlation analysis showed that there was a high positive correlation between anxiety and depression (r=0.605, P < 0.01), anxiety and depression respectively had a significantly positive correlation with personality of neuroticism and psychoticism scores, expenses and days of hospitalization (P < 0.05), but respectively had significantly negative correlation with perceived social support, introversion and extraversion, lie (P < 0.05). The standard scores of anxiety and depression were significantly higher in the fracture group than in the control group (P < 0.01). ② Scores of SAS and SDS in the fracture group were regarded as dependent variables and age as independent variables when we performed simple linear regression analysis. Regression equation of anxiety was Y=41.441+0.161X, and regression equation of depression was Y=42.966+0.169X. The level of anxiety was significantly different in fracture patients of different age (F=10.886, P < 0.01); The level of depression was significantly different in fracture patients of different age (F=14.946, P < 0.01). Scores of anxiety and depression were increased gradually with aging. ③ Scores of SAS and SDS in the fracture group were regarded as dependent variables and gender, age, marriage, education degree, vocation, income per year, fracture position, operation, physical disease, expenses and days of hospitalization, insurance, personality, perceived social support as independent variables when we did Backward multiple linear stepwise regression analysis. It showed that there were five factors entered regression equation of anxiety, they were perceived social support, personality of neuroticism score, gender, days of hospitalization and single; And there were six factors entered the regression equation of depression, they were personality of neuroticism score, perceived social support, expenses of hospitalization, unmarried, physical disease and education degree. CONCLUSION: It is concluded that the levels of anxiety and depression are very high in fracture inpatients, and it is associated with multi-factors. Perceived social support, personality of neuroticism score, gender, days of hospitalization and single have influence on anxiety of fracture patients, and personality of neuroticism score, perceived social support, expenses of hospitalization, unmarried, physical disease and education degree have influence on depression of fracture patients.更多还原