【作者】 高冬梅；

【导师】 乔明琦；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2009， 博士

【副题名】生活事件与特质怒及怒表达相关性流行病学调查

【摘要】 目的:中医七情致病已成为当今社会关注的焦点。七情中的怒是负性情绪中最不可忍受、对人际关系与社会和谐影响最大、与疾病发生关系最为密切的情绪反应之一,怒对人的身心健康造成的危害,越来越受到人们的重视。“生活事件”是个体愿望受阻、行为受挫而导致怒产生的主要原因,也是怒的始发因素。但当今社会环境下,关于引发个体发怒的主要生活事件是什么?有哪些?到目前为止,尚未明确。本研究结合美国南佛罗里达大学Speilberger教授观点与我们前期研究成果,认为怒的三个维度中,特质怒和怒表达与生活事件关系密切。因此,本研究在此基础上,将研究目光拓展前移到生活事件,以能触及到怒实质的特质怒与怒表达为切入点,探讨生活事件与怒的相关性及生活事件在怒产生中的归因危险度。以期了解当今社会下,引发怒及愤怒、郁怒情绪的主要生活事件有哪些,提出“生活事件是引发怒情志反应的始发因素”新假说。研究结果将为正确认识和预防怒对人身心健康造成的危害提供新依据和理论导向,从病因学角度为怒致病提供相关理论依据和数据支持,为七情内伤学说增添怒情志产生原因的病因学新认识,进而拓展七情学说。方法:采用理论探讨和流行病学调查对引发怒情志反应的始发因素进行研究。一方面,主要围绕怒与生活事件历代文献梳理进行理论探讨,得出“现行《中医基础理论》教科书中七情内伤学说忽略了引起怒情绪反应的外界原因”结论。另一方面,采用流行病学横断面调查的方法,根据怒的流行特点及资料显示,选取济南市与怒关系密切的护士(845人)、大学生(1420人)两个职业群体为目标人群,由经过专门培训的调查人员,使用事先设计好的调查工具进行调查,受试者一次性填写《一般情况调查问卷》、《State-trait Anger Expression Inventory -Ⅱ,STAXI-2》、《生活事件量表》三个调查问卷。使用《STAXI-2》中特质怒量表筛选高、低特质怒人群,向外表达(AX-O)量表筛选愤怒者,向内表达(AX-I)量表筛选郁怒者,把这四类人群作为研究对象,应用二项Logistic回归分别统计高特质怒、愤怒、郁怒与生活事件的相关性,分析高特质怒人群中引发怒情志的主要生活事件及在愤怒者、郁怒者中引发愤怒、郁怒情绪的生活事件。在筛选出的生活事件中,OR值﹥1作为引发怒及愤怒、郁怒的危险性因素,OR值﹤1作为引发怒及愤怒、郁怒的保护性因素,在此基础上进一步分析二者的归因危险度AR值、AR%及人群归因危险度PAR、PAR%。结果:在大学生、护士群体中,分别筛选出与高特质怒正相关的生活事件。在高特质怒大学生中,生活事件中“父母不和”(OR=1.04, 95%,IC=1.007～1.08)、“住房紧张”(OR=1.11, 95%,IC=1.028～1.19)、“待业、无业”(OR=1.10, 95%,IC=1.005～1.20)、“生活规律变动大”(OR=1.08, 95% IC=1.022～1.14)与高特质怒呈正相关。在高特质怒护士中,生活事件“与爱人父母不和”(OR=2.29,95%IC=1.17～4.51)、“扣发奖金或罚款”(OR=2.15,95%IC=1.13～4.09)、“对现职工作不满”(OR=1.71,95%IC=1.16～2.60)与高特质怒正相关。事件中“开始就业”(OR=0.16, 95%,IC=0.47～0.95)、“好友死亡”(OR=0.16, 95%,IC=0.4～0.68)与高特质怒呈负相关。对引起怒情志反应的诸多生活事件进一步统计分析表明:在高特质怒大学生中,与高特质怒正相关的生活事件也是高特质怒大学生发怒的危险因素。在高特质怒护士群体中,“与爱人父母不和”(OR=2.29)、“扣发奖金或罚款”(OR=2.15)、“对现职工作不满”(OR=1.71)是高特质怒护士发怒的较大危险因素。在愤怒大学生中,“恋爱或订婚”,“好友重病或重伤”生活事件与愤怒正相关,而“好友重病或重伤”(OR=1.90)是诸多事件中产生愤怒情绪危险因素;在郁怒大学生中,“工作学习压力大”与郁怒呈正相关,说明经历“工作学习压力大”易产生郁怒情绪。在愤怒护士群体中“怀孕”、“与爱人父母不和”、“待业、无业”生活事件与愤怒正相关。其中“与爱人父母不和”(OR=2.92)、“待业、无业”(OR=4.64)是护士产生愤怒情绪最大的危险因素;在郁怒护士群体中,“恋爱失败、破裂”(OR=2.29)和“高考失败”(OR=3.28)生活事件不但是引发护士郁怒情绪的主要生活事件,而且也是护士产生郁怒情绪的重要危险因素。对上述事件产生怒及愤怒郁怒归因危险度百分比分析(AR%),研究对象产生怒及愤怒郁怒情绪的原因分别76.9%、78.5%、62.9%、77.0%、72.7%归因于经历生活事件“与爱人父母不和”、“扣发奖金或罚款”、“对现职工作不满”、“待业、无业”、“高考失败”。在整个人群中,上述生活事件比其他生活事件的人群归因危险度PAR、人群归因危险度PAR%高,PAR值在8‰～47‰之间,PAR%在23%～61%之间,说明在整个人群中,这一组生活事件是人群产生怒及愤怒郁怒的主要原因。结论:研究结果以怒的不同侧面与生活事件相关支持假说,即生活事件作为刺激原可以引起怒及愤怒郁怒情志反应,是“阻碍个体愿望实现导致怒产生的充分条件,在某些情境下甚至是必要条件”。这将拓展中医情志内伤病因学,从病因学角度为愤怒、郁怒产生及其发病机制提供相关理论依据和数据支持,为七情内伤学说增添新内容。中西医学和心理学可能将依据本研究结果寻找出针对引发负性情绪的外界因素与情志刺激的心理有效干预方式和途径,为提高情志病证早期防治水平提供理论依据。更多还原

【Abstract】 Objectives: Diseases are induced by seven emotions, which have been concern focus in today’s society. Anger is one of seven emotions response, which can not tolerate, is the greatest impact on the harmonious society and is most closely related with the diseases in the negative emotion. The person’s physical and mental were caused by anger , which was been more and more attention by people.“Life events”is the main reason of anger-triggered, which is desire to delay and acts to frustrate, and also is originating factors of anger-triggered. But what is the main reason of anger-triggered? Which are they? So far, it does not yet clear. According to study of American south florida professor Speilberger, anger is classified three dimensions, which are state-anger, trait-anger, anger expression and anger control. In recent years foreign substantial research data demonstrated that they were intimate relation between trait-anger, anger expression and diseases in the three dimensions of anger, life events were served as external factors, which played an important role in the process anger induced diseases, but not clarified real reasons in the anger induced diseases. We found that they were close relation between external factors and emotional stimulus in the protoplasm study, and deemed that“external factors obstructed wish fulfillment, which was sufficient condition of giving rise to anger, even it was necessary condition of it under certain circumstance, external stimulus were the root of emotional practice, existence of stimulating cases were real reason of emotion induced diseases”.On the basis of them, research vision was expanded and shifted forward to external social context factors, touched the essence of anger of trait-anger and anger expression was regarded as point cut, to study relevance both it and life events, in order to know present-day society, which life events did trigger anger, anger-out and anger-in? To propose new hypothesis of“life events are originating factors of anger-triggered emotional action”. Research results will provide new basis and theory-oriented for correct understanding and preventing from caused on the person’s physical and mental harm by anger. They will expand traditional Chinese medicine emotional injuries etiology, it will provide related theoretical basis and data to support for the perspective of etiology, and it will add to new content for emotional injuries etiology.Methods: Adopted theory of discussion and epidemiological investigation to study on“life events are originating factors of anger-triggered emotional action”.On the one hand, we discussed correlation life events and anger, and drew the conclusion, which ignored the causes of anger in the previous studies. On the other hand, cross-sectional study using epidemiological methods, according to popular features of anger and data demonstrated, chose nurses 845 and undergraduate students 1420, which were closely related with anger, they were regarded as target population. Via specially trained investigators, used designed survey instrument well in advance to investigate, subject disposable filled <state-trait anger expression inventory-Ⅱ, STAXI-2>、< Life events scale>. Separately used trait-anger scale to choose high ,low trait-anger population in the < STAXI-2>, used <AX-O>to choose anger-out population, used <AX-I>to choose anger-in population in the < STAXI-2>, four categories of people separately served as study object. Used logistic regression statistics separately the relevance both high trait-anger, anger-out, anger-in and life events, to analyze main life events of anger-triggered emotion in population with high trait-anger, and to analyze main life events of anger-out /in-triggered in population with anger-out /in. In the life events, OR﹥1 is served as risk factors of anger-triggered and anger-out/in-triggered, OR﹤1 is took for protective factors of anger-triggered and anger-out/in-triggered.And further analyzed attributable risk(AR),attributable risk percent( AR % ), population attributable risk(PAR), population attributable risk percent( PARP or PAR%) of them.Results: In the university students with high trait-anger, positive correlations were found between“parent disharmony”(OR=1.04,95%IC=1.007～1.08),“housing nervous”(OR=1.11,95%IC=1.028～1.19),“unemployed”(OR=1.10,95%IC=1.005～1.20),“living the law of change in large”(OR=1.08,95%IC=1.022～1.14)and high trait-anger. In the nurses with high trait-anger, positive correlations were brought to light between“lover and parent disharmony”,“withholding bonuses or forfeit”( OR=2.15,95 % IC=1.13～4.09 ) ,“dissatisfied with level of job”(OR=0.16,95%IC=0.47～0.95); negative correlations were discovered between“start of employment”(OR=0.16,95%IC=0.47～0.95),“friends of death”(OR=0.16,95%IC=0.4～0.68). Further statistical analysis showed that triggering anger emotion in university student population with high trait-anger was triggered main life events, which were risk factors in them. In nurses population with high trait-anger“lover and parent disharmony”OR=2.29),“withholding bonuses or forfeit”(OR=2.15),“dissatisfied with level of job”(OR=1.71)were greater risk factors, which triggered anger emotion in nurses population with high trait-anger.Analyzed attributable risk percent of the life events, triggered anger and anger-oue/in respectively 76.9%、78.5%、62.9%、77.0%、72.7% attributed to life events ,which were“lover and parent disharmony”,“withholding bonuses or forfeit”,“dissatisfied with level of job”,“unemployed”. Their population attributable risk(PAR) and population attributable risk percent(PARP or PAR%)was from 8‰to 47‰, PAR%was from 23% to 61%.Results showed that a group of life events were the main reason of anger-triggered, anger-out/in-triggered in the whole population.Conclusions: Research results supported the hypothesis, which was correlation both different aspects of anger and life events, in other words, life events were served as stimulate source, which can arouse anger, anger-out and anger-in reaction, which deemed that“external factors obstructed wish fulfillment, which was sufficient condition of giving rise to anger, even it was necessary condition of it under certain circumstance”. Research results will expand traditional Chinese medicine emotional injuries etiology, from the perspective of etiology it will provide related theoretical basis and data to support, and it will add to new content for emotional injuries etiology. Traditional Chinese medicine, western medicine and psychology may look for external factors of triggering negative emotion and ways and means of effective psychological intervention of emotional stimulus, and support theoretical basis for enhancing level of early prevention and treatment of diseases induced by emotion.更多还原