癌症相关创伤后应激障碍临床心理特征与心率变异性的相关研究

发布时间：2018-06-12 01:12

本文选题：癌症 + 创伤后应激障碍　；参考：《苏州大学》2013年硕士论文

【摘要】：目的：本研究采用病例-对照的方法，探讨癌症相关创伤后应激障碍（cancer-relatedPTSD）的发生率、临床症状特征、心理社会影响因素、自主神经功能变化，分析PTSD核心症状与心率变异性(HRV)的相关性，探讨评价PTSD核心症状的客观生物学指标，为癌症相关PTSD的早期识别、临床诊断及干预治疗提供依据。方法：通过临床用创伤后应激障碍诊断量表(CAPS)对150例癌症患者进行诊断性访谈，采用创伤后应激障碍自评量表（PCL-C）对PTSD组（n=37）和对照组（n=30）进行PTSD严重程度评估，完成一般情况调查表、T型心理量表（TP）、癌症应对问卷（CCMQ）、领悟社会支持量表（PSSS）。采用生理相干与自主神经平衡系统对PTSD组、对照组、健康组（n=30）进行心率变异性检测，评定自主神经功能，分析HRV相关指标与PTSD核心症状的相关性。结果：1.癌症相关PTSD的临床特征及心理社会影响因素：（1）癌症相关PTSD的总体发生率为24.67%，不同癌症类型的PTSD发生率在14.29%（食管癌）至57.14%（卵巢癌）之间，无明显统计学差异（P0.05）；不同病程长短的PTSD发生率均为25%左右，无明显统计学差异（P0.05）；复发或转移患者PTSD的发生率（45.28%）显著高于无复发或转移者（13.40%）（P0.01）；（2）PTSD组三大核心症状：再体验（16.78±2.32）、回避（20.92±3.51）、警觉增高（18.00±2.27）均显著高于对照组（P0.01），三大核心症状中以警觉增高最为显著；（3）通过单因素分析，负债的癌症患者PTSD的发生率显著高于无负债者（P0.01），经多因素分析，复发或转移是癌症相关PTSD的危险因素；（4）PTSD组TP总分（2.38±0.33）、认知习惯（2.64±0.35）、情绪表现（2.40±0.50）、个性特征（2.47±0.44）显著高于对照组（P0.01），癌症相关PTSD症状的严重程度与TP总分、认知习惯、情绪表现、个性特征显著正相关（r=0.655、0.559、0.461、0.703，P0.01或P0.05）；(5) PTSD组较少采取面对（1.95±0.45）的应对方式，而多采用回避和压抑（2.30±0.44）、屈服（2.45±0.72）、幻想（2.32±0.50）、发泄（2.16±0.53）的应对方式（P0.01或P0.05），癌症相关PTSD症状的严重程度与面对的应对方式显著负相关（r=-0.452，P0.01），与回避和压抑、屈服、发泄显著正相关（r=0.492、0.346、0.352，P0.01或P0.05）；（6）PTSD组PSSS总分（55.49±9.34）、家庭内支持（20.73±3.85）和家庭外支持（34.76±6.30）明显低于对照组（P0.01），癌症相关PTSD症状的严重程度与PSSS总分、家庭内支持、家庭外支持显著负相关（r=-0.808、-0.673、-0.786，P0.01）。 2.癌症相关PTSD患者的心率变异性：（1）平静状态下，PTSD组SDNN（61.54±13.10）和HF（50.69±13.10）显著下降，LF/HF(7.70±3.34)显著升高（P 0.01）；(2)应激状态下，PTSD组SDNN应激差值（-4.32±3.52）明显低于对照组（-10.00±3.94）（P0.01），HF和LF/HF应激差值（-17.06±3.96、5.80±0.95）显著高于对照组（-8.46±4.53、3.55±0.95）（P0.01）；(3) SDNN与PCL-L总分、再体验、回避和警觉增高负相关（r=-0.741、-0.565、-0.672、-0.430，P0.01），LF与PCL-L总分、再体验、回避正相关（r=0.464、0.359、0.449，P0.01或P0.05），HF与PCL-L总分、再体验、回避和警觉增高负相关（r=-0.675、-0.475、-0.407、-0.746，，P0.01或P0.05），LF/HF与PCL-L总分、再体验、回避和警觉增高正相关（r=0.719、0.466、0.553、0.651，P0.01）。(4)领悟社会支持总分、T型心理量表-个性特征、应对方式-发泄、心率变异性-HF等4个自变量被选入影响PTSD严重程度总分的回归方程。结论：1.癌症患者具有较高的PTSD发生率，三大核心症状中以警觉增高最为显著；2.负债、癌症复发或转移的患者PTSD的发生率显著增高；个性不健全、应对方式不良、领悟社会支持低与癌症相关PTSD的严重程度密切相关；3.癌症相关PTSD患者的自主神经系统功能紊乱，迷走神经系统功能抑制，交感神经系统功能增强；4.癌症相关PTSD三大核心症状越严重，HRV指标改变越明显，HRV与癌症相关PTSD的严重程度密切相关；5.癌症相关PTSD的危险因素包含心理、社会、神经生理等多方面，临床上对癌症相关PTSD患者应采取生物心理社会综合干预策略。
[Abstract]:Objective: To investigate the incidence of cancer related posttraumatic stress disorder (cancer-relatedPTSD), clinical symptoms, psychosocial factors, autonomic nervous function changes, analysis of the correlation between PTSD core symptoms and heart rate variability (HRV), and to explore the objective biological indicators for evaluating the core symptoms of PTSD. To provide evidence for early diagnosis, clinical diagnosis and intervention treatment of cancer-related PTSD.
Methods: 150 cases of cancer patients were interviewed by clinical use of posttraumatic stress disorder diagnostic scale (CAPS) and PTSD severity assessment was carried out in group PTSD (n=37) and control group (n=30) by posttraumatic stress disorder self rating scale (PCL-C). The general situation questionnaire, T mental scale (TP), cancer Coping Questionnaire (CCMQ), and understanding society were completed. The physiological coherence and autonomic nerve balance system was used to detect the heart rate variability in the PTSD group, the control group and the healthy group (n=30), to evaluate the autonomic nerve function and to analyze the correlation between the HRV related indexes and the PTSD core symptoms by the physiological coherence and autonomic nervous system (PSSS).
Results: 1. the clinical and psychosocial factors of cancer related PTSD were: (1) the overall incidence of cancer related PTSD was 24.67%, the incidence of PTSD in different cancer types was between 14.29% (esophageal cancer) and 57.14% (ovarian cancer), there was no significant difference (P0.05), and the incidence of PTSD in different course of disease was about 25%, and no significant statistics were found. The incidence of PTSD (P0.05) in patients with recurrent or metastatic (45.28%) was significantly higher than that of those without relapse or metastasis (13.40%) (P0.01); (2) three core symptoms in group PTSD: re experience (16.78 + 2.32), avoidance (20.92 + 3.51), increased vigilance (18 + 2.27) significantly higher than that of the control group (P0.01), and the most significant increased vigilance among the three core symptoms (3); (3) Through single factor analysis, the incidence of PTSD in cancer patients was significantly higher than that of non indebted persons (P0.01). After multiple factors analysis, recurrence or metastasis was a risk factor for cancer related PTSD; (4) the total score of TP in group PTSD (2.38 + 0.33), cognitive habit (2.64 + 0.35), emotional expression (2.40 + 0.50), and personality characteristics (2.47 + 0.44) were significantly higher than that of the control group (P0.01). The severity of cancer related PTSD symptoms was significantly correlated with the total score of TP, cognitive habits, emotional expression, and personality traits (r=0.655,0.559,0.461,0.703, P0.01 or P0.05); (5) the group PTSD had less to face (1.95 + 0.45) coping styles, but more use of avoidance and depression (2.30 + 0.44), yield (2.45 + 0.72), fantasy (2.32 + 0.50), and venting (2.16 + 0.53). Coping style (P0.01 or P0.05), the severity of cancer related PTSD symptoms was significantly negatively correlated with coping styles (r=-0.452, P0.01), significantly positively correlated with avoidance and depression, yield, and venting (r=0.492,0.346,0.352, P0.01 or P0.05), (6) PSSS total in the PTSD group (55.49 + 9.34), family support (20.73 + 3.85) and external support (34.76 + 6.). 30) significantly lower than the control group (P0.01), and the severity of cancer related PTSD symptoms was significantly negatively correlated with PSSS total, family support, and external support (r=-0.808, -0.673, -0.786, P0.01).
2. the heart rate variability of patients with cancer related PTSD: (1) in the calm state, SDNN (61.54 + 13.10) and HF (50.69 + 13.10) decreased significantly in group PTSD, and LF/HF (7.70 + 3.34) significantly increased (P 0.01). (2) the difference of SDNN stress (-4.32 + 3.52) in PTSD group was lower than that of the control group (-10.00 + 3.94) (P0.01), and the difference between HF and stress stress (P0.01) was significantly lower than that of the control group (P0.01). + 0.95) was significantly higher than that of the control group (-8.46 + 4.53,3.55 + 0.95) (P0.01); (3) SDNN and PCL-L total score, re experience, avoidance and alertness increased negative correlation (r=-0.741, -0.565, -0.672, -0.430, P0.01), LF and PCL-L total, re experience, avoidance and total score, re experience, avoidance and heighten negative correlation ( R=-0.675, -0.475, -0.407, -0.746, P0.01 or P0.05), LF/HF and PCL-L total score, re experience, avoidance and vigilance positive correlation (r=0.719,0.466,0.553,0.651, P0.01). (4) comprehend social support total score, T type psychological scale - personality characteristics, coping style - vent, heart rate variability -HF, and other 4 independent variables were selected to influence the total score of the severity of the regression Equation.
Conclusion: 1. the incidence of PTSD in cancer patients is higher, and the three core symptoms are most significantly increased in vigilance; 2. liabilities, and the incidence of PTSD in patients with cancer recurrence or metastasis is significantly higher; personality is unsound, coping style is poor, social support is low and the severity of cancer related PTSD is closely related; 3. cancer related PTSD patients The dysfunction of the autonomic nervous system, the function inhibition of the vagus nerve system, and the enhancement of the sympathetic nervous system function; 4. the more serious the PTSD three core symptoms of cancer related, the more obvious the changes of the HRV index, and the close correlation between the HRV and the severity of the cancer related PTSD; 5. the risk factors for cancer related PTSD include psychological, social, neurophysiology and many other factors. Clinically, cancer related PTSD patients should adopt a biopsychosocial intervention strategy.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.5

【参考文献】