社区维吾尔族老年抑郁症现况调查及危险因素研究

发布时间：2018-07-24 20:56

【摘要】：背景老年抑郁症的主要表现为情绪低落、焦虑、迟滞和躯体不适等,它不能简单归同于躯体疾病和脑器质性病变,近年发病率有不断上升的趋势。老年抑郁症可导致老年人精神残疾和自杀行为,给社会、家庭和个人带来极大的负担。国内外已对老年抑郁症做了大量的研究,但新疆针对维吾尔族老年抑郁症的现状研究较少。新疆60岁以上的老年人占10.93%,标志着新疆已进入老龄化社会。新疆老龄化具有农村老龄化程度高于城镇,少数民族老龄人口数量高于汉族老龄人口,老年人口健康状况较差的特点。维吾尔族老年人聚居地--和田曾经是世界长寿地区之一。维吾尔族老年人群的心身健康状况如何值得关注。老年人较少会主动咨询心理医生来解决貌似躯体疾病的心身问题,导致老年抑郁症漏诊现象严重。社区筛查可以使维吾尔族老年人的身心健康得到初步保障。目前尚无专门应用维吾尔族语言筛查维吾尔族老年抑郁症等精神状况的评定量表,借鉴国内外经验开发一套维文版量表在维吾尔族老年人群中使用,对健康老龄化发展意义重大。老年抑郁症病因复杂,它包含了社会、心理、免疫等多重作用的结果。对于社区首发维吾尔族老年抑郁症的病例对照研究可以避免受医院药物和各种人为干扰因素的影响,较为客观的探索各种社会影响因素及生化、免疫学指标对该疾病的影响作用,为探讨病因研究奠定基础。目的(1)验证维文版GMS量表的使用效能,评价该量表的可行性、信度、效度等指标。(2)在社区筛查维吾尔族老年抑郁症,了解维吾尔族老年抑郁症患病率及社会影响因素。(3)开展病例对照研究,比较躯体机能指标和血脂、细胞因子在维吾尔族老年抑郁症和正常对照组之间的差别,为老年抑郁症的病因学研究奠定基础。方法本课题包含三部分内容：(1)第一部分：研究工具的选择和应用：运用量表翻译、回译和文化调试方法翻译GMS量表为维文版,在社区和医院门诊进行维文版GMS量表信度和效度的考核。(2)第二部分：维吾尔族老年抑郁症的现况调查：采取两阶段随机分层抽样在新疆维吾尔族人群较为集中的南疆、北疆和东疆各随机抽取一个城市和农村,再次随机抽取该地区的社区或村,根据纳入／排除标准在维吾尔族老年人群中运用维文版GMS量表开展老年抑郁症问卷调查,调查内容还包含各种社会影响因素如：自评生活和健康的满意现状,社会支持现状,自述躯体疾病的种类及数量,生活自理能力等方面。运用logistic回归模型对维吾尔族老年抑郁症的相关社会影响因素进行分析。(3)第三部分：维吾尔族老年抑郁症病例对照研究：在前期现况调查的基础上,经精神科医生根据CCMD-3诊断标准确诊维吾尔族老年抑郁症,随机抽取病例54例,并在同样地区进行配对健康对照48例,测量体重、身高等躯体机能指标,检测血脂系列、血清细胞因子IL-1β、IL、IL-6、TNF-α等指标在病例与对照组之间的差异,明确这些指标与维吾尔族老年抑郁症的关系。结果(1)维文版GMS量表在新疆维吾尔族老年人中可行性较好,具有较好的信度和效度：维语版GMS量表的总Cronbach'a系数为0.963；评定者问一致系数为0.930；全量表的重测信度为0.870。专家内容效度(CVI值)为0.856；以CCMD3医生诊断为标准测定校标效度,老年抑郁症的诊断符合率为84.00%,灵敏度为85.42%(41/48),特异度为82.69%(43/52),阳性预测值为82.00%(41/50),阴性预测值为86.00%(43/50),Kappa=0.68(P=0.00)。(2)本次调查城乡社区维吾尔族老年抑郁症患病率为10.60%,城市社区患病率为2.80%,农村患病率为23.60%；男性患病率为5.91%,女性患病率为14.58%,女性是男性患病率的2.717倍(χ2=24.572,95%的可信区间：1.830-4.035)；(3)本次调查维吾尔族老年抑郁症单因素分析显示：维吾尔族老年抑郁症的发生在婚姻状况(χ2=1.853,P=0.603)、年龄(χ2=0.304,P=0.959)的差异无统计学意义,在文化程度(χ2=17.548,P=0.002)、职业(χ2=31.366,P=0.000)的差异有统计学意义；在吸烟(χ2=0.700,P=0.403)饮酒(χ2=0.082,P=0.775)的生活方式差异无统计学意义；维吾尔族老年抑郁症的发生与是否参加集体旅游(x2=10.137,P=0.001)、是否参加社区活动(χ2=11.087,P=0.001)、是否打牌(χ2=18.071,P=0.000)、是否打麻将(χ2=5.021,P=0.025)、是否下棋(χ2=6.349,P=0.011)、是否经常散步(χ2=7.676,P=0.006)有相关性,其差异有统计学意义；社区维吾尔族老年抑郁症患者在自评健康状况中的差异有统计学意义(χ2=37.604,P=0.000)；患有一种以上躯体疾病的维族老年人所占比例占总人数的61.93%,3种以上躯体疾病人数占总人数的28.37%,患抑郁症的比率高达22.02%；维吾尔族老年人日常生活能力损害率为3.83%；维吾尔族老年人与家人相处不融洽患抑郁症的比率是相处融洽的2.184倍(χ2=4.840,95%的可信区间：1.089-4.382)；维族老年人负性生活事件数量中,3件以上发生抑郁症的几率是20.43%,负性生活事件中经济困难(χ2=13.559,95%的可信区间：1.449-3.518)和亲人去世(χ2=10.695,95%的可信区间：1.289-2.828)的差异有统计学意义,发生经济困难引发老年抑郁症的几率是没有经济困难老年人的2.258倍。日常活动能力正常的老年人对抑郁症的发生是一种保护因素,其OR值为0.217(χ2=14.709,95%的可信区间：0.099-0.474),经检验差异有统计学意义。(4)本次调查维吾尔族老年抑郁症多因素logistic回归分析显示：老年抑郁症的发生与女性、自评健康状况差、有痴呆病史、患有中风或部分瘫痪以及躯体疾病的数量、不同区域与维吾尔族老年抑郁症有关联；城乡分层多因素Logistic回归分析结果显示：城市维吾尔族老年人自评健康状况差,患有身体中风和部分瘫痪,偏头痛,参加宗教组织活动,负性生活事件等与维吾尔族老年抑郁症有关联；农村维吾尔族老年人自评健康状况差,女性,有抑郁症病史、痴呆症病史以及躯体疾病数量对老年抑郁症有影响。自评健康状况的好坏和躯体疾病数量与维吾尔族老年抑郁症有关联。(5)病例对照研究发现：病例组与对照组的收缩压(t=2.697,P=0.008)、体重(t=2.153,P=-0.034)值差异有统计学意义,但两组的时测收缩压都在正常范围之内(对照组130.611±14.215,抑郁组137±8.693)；病例组甘油三脂高于对照组,经检验其差异有统计学意义t=2.084,P=-0.04,其余血脂指标的差异均无统计学意义；病例组TNF-a指标明显高于对照组,经检验其差异有统计学意义(t=3.675,P=0.001),而IL-1β、IL-6、IL-2指标与健康对照组相比较差异无统计学意义。结论(1)维文版GMS量表具有较好的信度及效度,诊断效能较好,可以在新疆社区维吾尔族老年人群中筛查老年抑郁症。(2)维吾尔族老年抑郁症患病率较高,与自评健康状况差和躯体疾病数量较多有密切的关系,应引起社会重视。城市老年抑郁症患病率与内地城市相当,但农村老年抑郁症患病率明显高于内地,与农村维吾尔族老年人躯体疾病较多,自评健康状况较差,女性社会地位较低,中风或偏瘫的病史有关。维吾尔族老年人忌烟限酒、大家庭聚居、与周围邻居相处融洽是其心身健康的保护因素,但较少参与传统的智力游戏活动,自评经济困难,自评健康状况差,躯体疾病数量增加,负性生活事件的增多对维吾尔族老年人心身健康有负面影响。(3)血压、体重以及甘油三脂的升高进一步增加了维吾尔族老年人患抑郁症的风险。血清细胞因子TNF-a对维吾尔族老年抑郁症有影响。鉴于本研究针对维吾尔人群,样本来自社区人群且各种干扰因素较少,今后需进一步增加病例对照研究的样本量论证血清细胞因子在老年抑郁症中的作用和相关性。
[Abstract]:Background depression is the main manifestation of depression, anxiety, retardation and physical discomfort. It can not be attributed to somatic disease and cerebral organic disease. In recent years, the incidence of senile depression has a rising trend. Senile depression can lead to mental disability and suicidal behavior of old people, and bring great burden to society, family and individual. A lot of research has been done on geriatric depression, but there is little research on the status quo of the Uygur depression in Xinjiang. The aged people over 60 years old in Xinjiang account for 10.93%, which indicates that Xinjiang has entered an aging society. The aging of Xinjiang has a higher degree of aging in rural areas than in cities and towns, and the number of old people in ethnic minorities is higher than that of the Han population. Old people are older than the Han people. The health status of the old people in Uygur people is one of the world longevity areas. The mental health of the elderly Uygur people is worth paying attention to. The elderly are less likely to consult the psychologist to solve the psychosomatic problems that appear to be similar to the body disease, which leads to the serious misdiagnosis of senile depression. Community screening can ensure the physical and mental health of the Uygur people. At present, there is no special application of Uygur language to screen the mental status of Uygur elderly depression. It is useful for the Uygur people to develop a set of Uygur version scale for reference, and it is of significance to the development of healthy aging. The cause of the elderly depression is complex, which includes the results of social, psychological, immune and other multiple effects. The case control study of the first Uygur depression in the community can avoid the influence of hospital drugs and all kinds of human interference factors, and more objectively explore various social factors and biochemistry, and the immunological index is the same. The impact of the disease to study the cause of the cause of the study. Objective (1) to verify the effectiveness of the version of the GMS scale, to evaluate the feasibility, reliability and validity of the scale. (2) in community screening of Uygur senile depression, the prevalence and social factors of Uygur depression and social influence factors. (3) a case control study was carried out. The difference between the body function index and the blood lipid, the cytokine in the Uygur depression and the normal control group is the basis for the etiological study of the senile depression. Methods this topic includes three parts: (1) the first part: the selection and application of the research tools: using scale translation, back translation and cultural debugging methods to translate G The MS scale is the version of the Uygur version and the assessment of the reliability and validity of the GMS scale in the community and hospital outpatients. (2) the second part: the current situation of the Uygur elderly depression: Taking the two stage random stratified sampling in the South Xinjiang, the North Xinjiang and the East Xinjiang, the city and the countryside of the north and East Xinjiang are randomly selected in Xinjiang. The community or village of the area was randomly selected. According to the inclusion / exclusion criteria, the Uygur version of the GMS scale was used to carry out a questionnaire survey on geriatric depression. The contents of the survey included various social factors, such as self evaluation of life and health, status of social support, the type and quantity of self described somatic disease. The logistic regression model was used to analyze the related social factors related to the Uygur depression. (3) the third part: a case control study of the Uygur depression: on the basis of the prophase status survey, the psychiatrists confirmed the Uygur depression according to the CCMD-3 diagnostic criteria. 54 cases were randomly selected and 48 cases were matched in the same area. The body weight, height and other body function indexes were measured, the blood lipid series, serum cytokine IL-1 beta, IL, IL-6, TNF- alpha were different between the cases and the control group, and the relationship between these indexes and the Uygur depression was clearly defined. Results (1) the GMS quantity of the Uygur version The table has good reliability and validity among the Uygur people in Xinjiang, which has good reliability and validity: the total Cronbach'a coefficient of the GMS scale of the Uygur version is 0.963; the consensus coefficient of the assessor is 0.930; the retest reliability of the total scale is 0.856 of the 0.870. expert content validity (CVI value); the calibration validity is determined by the standard of doctor CCMD3 and the old age is suppressed. The diagnostic coincidence rate of depression was 84%, the sensitivity was 85.42% (41/48), the specificity was 82.69% (43/52), the positive predictive value was 82% (41/50), the negative predictive value was 86% (43/50), Kappa=0.68 (P=0.00). (2) the prevalence rate of Uygur depression in urban and rural communities was 10.60%, the urban community prevalence rate was 2.80% and the rural prevalence rate was 23.60%. The male prevalence rate was 5.91%, the female prevalence rate was 14.58%, the female was 2.717 times the male prevalence rate (the X 2=24.572,95% confidence interval: 1.830-4.035); (3) the single factor analysis of Uygur senile depression showed that the occurrence of Uygur depression was in marital status (x 2=1.853, P=0.603), age (x 2=0.304, P=0.959). There was no statistically significant difference in the difference in educational level (chi 2=17.548, P=0.002), occupation (chi 2=31.366, P=0.000), and there was no significant difference in the lifestyle difference between smoking (chi 2=0.700, P=0.403) drinking (chi 2=0.082, P=0.775), and the occurrence of old age depression in Uygur and whether to participate in collective tourism (x2=10.137, P=0.001). Whether to participate in the community activities (chi 2=11.087, P=0.001), whether to play cards (chi 2=18.071, P=0.000), whether to play mahjong (chi 2=5.021, P=0.025), whether to go chess (chi 2=6.349, P=0.011), whether the frequent walk (chi 2=7.676, P=0.006) is relevant, the difference is statistically significant; community Uygur depression in the health of the elderly patients in the health status of the difference is Statistical significance (2=37.604, P=0.000); the proportion of elderly people with more than one kind of physical disease accounted for 61.93% of the total, 3 or more kinds of physical diseases accounted for 28.37% of the total, the rate of depression was up to 22.02%, and the rate of daily living impairment of the Uygur people was 3.83%. The ratio of depression to depression was 2.184 times as good as that of harmony (the confidence interval of X 2=4.840,95%: 1.089-4.382); in the number of negative life events in the elderly, the risk of depression was 20.43%, the economic difficulties in negative life events (the confidence interval of the X 2=13.559,95%: 1.449-3.518) and the death of relatives (x 2=10.695,9) 5% of the confidence interval: 1.289-2.828) was statistically significant, and the risk of economic difficulties was 2.258 times as high as that of the elderly without economic difficulties. The elderly with normal daily activity were a protective factor for depression, and the OR value was 0.217 (x 2=14.709,95% confidence interval: 0.099-0.474). (4) the multi factor Logistic regression analysis of the Uygur depression showed that the occurrence of senile depression and the female, the poor health status, the history of dementia, the number of stroke or partial paralysis and the body disease, the different regions were associated with the Uygur depression, and the urban and rural areas were divided. The results of multi factor Logistic regression analysis showed that the health status of urban Uygur elderly was poor, suffering from physical apoplexy and partial paralysis, migraine, participation in religious organization and negative life events were associated with Uygur depression, and the health status of Uygur people in rural areas was poor, women and depression. History, the history of dementia and the number of somatosensory diseases had an impact on depression. The quality of health and the number of physical diseases were associated with the Uygur depression. (5) case control studies found that the systolic pressure (t=2.697, P=0.008) and weight (t=2.153, P=-0.034) of the case group and the control group were statistically significant, but two The systolic pressure of the group was within the normal range (130.611 + 14.215 in the control group and 137 in the depression group, 137 + 8.693). The difference of glycerol and three fat in the case group was higher than that of the control group. The difference was statistically significant t=2.084, P=-0.04, and the other blood lipid indexes were not statistically significant; the TNF-a index in the case group was significantly higher than that of the control group. Statistical significance (t=3.675, P=0.001), and IL-1 beta, IL-6, IL-2 indicators compared with the health control group, there is no statistical difference. Conclusion (1) the vien version GMS scale has better reliability and validity, the diagnostic efficiency is better, can be screened for elderly depression in the Xinjiang community Uygur elderly people. (2) the prevalence rate of Uygur depression is more than that of Uygur. The prevalence rate of senile depression in urban areas is similar to that in mainland cities, but the prevalence rate of elderly depression in rural areas is significantly higher than that in the mainland, and there are more physical diseases in the rural Uygur elderly, poor health and low social status in women. The history of apoplexy or hemiplegia is related to the medical history of the elderly in Uygur. The old people of the Uygur people avoid smoking limited wine, the large family live together, and the harmony with their neighbors is the protective factor for their health. However, they are less involved in the traditional intellectual game activities, self evaluation of economic difficulties, poor health status, the increase of the number of physical diseases, and the increase of negative life events to the Uygur people. Human health has a negative impact. (3) blood pressure, weight and the increase of glycerin three fat further increase the risk of depression in the Uygur elderly. Serum cytokine TNF-a has an impact on Uygur elderly depression. One step is to increase the sample size of case-control study to demonstrate the role and correlation of serum cytokines in senile depression.
【学位授予单位】：安徽医科大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R749.4

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