慢性疼痛患者抑郁依恋模型的构建

发布时间：2018-04-26 13:19

本文选题：慢性疼痛 + 抑郁　；参考：《山西医科大学》2013年硕士论文

【摘要】：研究目的通过分析慢性疼痛与灾难化认知、社会支持、依恋、抑郁之间的关系,构建慢性疼痛抑郁依恋模型,丰富国内有关慢性疼痛患者抑郁易感性机制的理论研究,为临床及早发现慢性疼痛合并抑郁患者及其康复提供心理学依据。研究方法本研究采用方便抽样法。调查对象为2012年9月至2013年1月重庆市西南医院类风湿关节炎310例住院患者。使用简化McGill疼痛问卷、SDS抑郁自评量表、中译版疼痛灾难化量表、社会支持评定量表和亲密关系体验问卷进行调查研究。研究结果 (1)疼痛状况：患者的疼痛年限以0-9年居多(64.21%)；多为慢性间断疼痛(69.57%)；感受到的疼痛强度多为重度疼痛(30.11%)；现时疼痛强度以疼痛不适(46.49%)为主。 (2)慢性疼痛患者合并抑郁情况：抑郁发生率为32.00%；无抑郁患者68.00%,轻微至轻度抑郁患者15.66%,中度至重度抑郁患者11.67%,重度抑郁患者4.67%。不同性别患者(p=0.226)、不同文化程度患者(p=0.225)抑郁程度并无显著差异；不同年龄阶段(p=0.041)、不同婚姻状况患者(p=0.007)、不同职业患者(p=0.001)、不同居住地患者(p=0.000)、不同医疗保险种类的患者(p=0.000)和不同家庭经济收入状况的患者(p=0.000)抑郁程度有显著性差异。 (3)依恋状况比较：依恋回避维度上显示,性别(p=0.014)和抑郁程度(p=0.000)不同的患者依恋回避具有显著性差异,不同年龄阶段患者(p=0.610)依恋回避不具有统计学意义；依恋焦虑维度上显示,不同性别(p=0.013)、不同年龄阶段(p=0.006)、不同抑郁程度(p=0.000)的患者在依恋焦虑上都有显著性差异。 (4)相关分析显示：慢性疼痛各维度与抑郁呈显著正相关(0.41,0.30,0.45,0.32)；依恋回避与慢性疼痛各维度呈正相关(0.15,0.03,0.17,0.04),依恋焦虑与慢性疼痛各维度呈正相关(0.22,0.11,0.19,0.25)；抑郁和依恋回避、依恋焦虑均呈显著正相关(0.34,0.41)。 (5)调节效应分析显示：依恋在慢性疼痛与抑郁的关系中起着调节作用(F=18.109,p=0.000)；依恋在疼痛灾难化与抑郁的关系中起着调节作用(F=27.658,p=0.000)；依恋在社会支持与抑郁的关系中起着调节作用(F=12.042,p=0.000)。 (6)慢性疼痛抑郁依恋模型分析显示：慢性疼痛以疼痛灾难化、社会支持和依恋为中介对抑郁的预测模型符合假设模型,模型拟合指标χ2/df=2.873,RMSEA=0.079, GFI=0.927, NFI=0.900, CFI=0.931。慢性疼痛对抑郁有四条作用路径：慢性疼痛→灾难化→抑郁,慢性疼痛→依恋→抑郁,慢性疼痛→依恋→灾难化→抑郁,慢性疼痛→依恋→社会支持→抑郁。研究结论 (1)患者的疼痛年限一般较长,多以间断性疼痛为主,患者感受到的疼痛强度各种程度都有,住院患者现时疼痛强度一般较低。 (2)慢性疼痛患者合并抑郁发生率较高,不同经济状况、疼痛强度、依恋特征的患者其抑郁有差异。 (3)依恋分别对疼痛强度、疼痛灾难化和社会支持与抑郁的关系具有调节作用。 (4)慢性疼痛是预测患者抑郁的一个重要因素,通过灾难化与依恋间接作用于抑郁；慢性疼痛以依恋、疼痛灾难化为中介对抑郁具有间接作用；慢性疼痛以依恋、社会支持为中介对抑郁具有间接作用。
[Abstract]:research objective
Through the analysis of the relationship between chronic pain and disastrous cognition, social support, attachment, and depression, the model of chronic pain and depression is constructed, and the theoretical research on the mechanism of depression and susceptibility to chronic pain in China is enriched to provide psychological basis for the early detection of chronic pain and depression in patients and their rehabilitation.
research method
A convenient sampling method was used in this study. The subjects were 310 patients with rheumatoid arthritis in Southwest Hospital of Chongqing from September 2012 to January 2013. The simplified McGill pain questionnaire, SDS depression self rating scale, the Chinese version of the Chinese version of the pain catastrophe scale, the social support rating scale and the intimate customs experience questionnaire were investigated.
Research results
(1) pain status: the patient's pain years are more than 0-9 years (64.21%); most of them are chronic discontinuous pain (69.57%); the pain intensity is more severe (30.11%), and the current pain intensity is mainly with pain discomfort (46.49%).
(2) the incidence of depression in patients with chronic pain was 32%, 68% without depression, 15.66% in mild to mild depression, 11.67% in moderate to severe depression, and for 4.67%. with different sex (p=0.226) in severe depressive patients (p=0.226), and there was no significant difference in the degree of depression in patients with different educational levels (P =0.225); p=0 .041), different marital status patients (p=0.007), different occupational patients (p=0.001), different residence patients (p=0.000), patients with different kinds of medical insurance (p=0.000) and patients with different family economic income (p=0.000) have significant difference in depression degree.
(3) comparison of attachment status: the attachment avoidance dimension showed that there were significant differences in attachment avoidance in patients with different sex (p=0.014) and depression degree (p=0.000). The attachment avoidance in different age groups (p=0.610) was not statistically significant; the attachment anxiety dimension showed that different sex (p=0.013), different age stage (p=0.006), different inhibition. Yu Chengdu (p=0.000) patients have significant differences in attachment anxiety.
(4) the correlation analysis showed that there was a significant positive correlation between all dimensions of chronic pain and depression (0.41,0.30,0.45,0.32); attachment avoidance was positively correlated with all dimensions of chronic pain (0.15,0.03,0.17,0.04); attachment anxiety was positively correlated with all dimensions of chronic pain (0.22,0.11,0.19,0.25); depression and attachment avoidance, and attachment anxiety were positively correlated (0.34, 0.41).
(5) the analysis of regulatory effect shows that attachment plays a regulatory role in the relationship between chronic pain and depression (F=18.109, p=0.000); attachment plays a regulatory role in the relationship between pain and depression (F=27.658, p=0.000), and attachment plays a regulatory role in the relationship between social support and depression (F=12.042, p=0.000).
(6) the analysis of chronic pain and depressive attachment model showed that chronic pain was disastrous with pain, and social support and attachment as the mediator conformed to the hypothetical model of depression. The model fitting index Chi 2/df=2.873, RMSEA=0.079, GFI=0.927, NFI=0.900, CFI=0.931. had four ways of chronic pain to depression: chronic pain - disastrous Depression, chronic pain, attachment, depression, chronic pain, attachment, disastrous depression, chronic pain, attachment, social support, depression.
research conclusion
(1) the patient's pain years are generally long, mostly with intermittent pain. The pain intensity of the patients is all in all degrees, and the pain intensity of the hospitalized patients is generally low.
(2) the incidence of depression in patients with chronic pain is relatively high. There are differences in depression among patients with different economic conditions, pain intensity and attachment characteristics.
(3) attachment has a moderating effect on the relationship between pain intensity, disastrous pain, and social support and depression.
(4) chronic pain is an important factor in predicting depression in patients, which indirectly affects depression through disastrous and attachment; chronic pain is dependent on attachment and pain disastrous as a mediator for depression; chronic pain is dependent on attachment, and social support is the intermediary for depression.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.41

【参考文献】