老年抑郁障碍患者抑郁主观体验与医师临床评估一致性的1年随访研究

发布时间：2019-06-03 19:38

【摘要】：目的:比较不同治疗阶段老年抑郁障碍患者抑郁主观体验与医师进行的临床评估的一致性,探讨其相关因素。方法:连续入组符合疾病和有关健康问题的国际统计分类第十次修订本(ICD-10)诊断抑郁障碍的老年患者69例,在基线、治疗2周末、4周末及52周随访4个时间点,患者用抑郁视觉标尺(VSD)完成抑郁主观体验的自我评估,医师用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)、简明精神状态检查表(MMSE)评估患者的抑郁症状、焦虑症状和认知功能评估。结果:重复测量方差分析显示,与基线相比,2周末和4周末时的VSD分[(2.7±1.6),(5.3±2.0)vs.(7.0±1.8),P0.001]增加,HAM D分[(36±11),(17±9)vs.(9±8),P0.001]、HAM A分下降[(27±10),(14±8)vs.(7±6),P0.001],4周末与52周随访时的得分差异均无统计学意义(P0.05)。基线及2周末患者VSD评分与HAMD、HAMA评分无相关性,4周末和52周时VSD与HAMD负相关(r=-0.31、-0.74,P0.05或P0.01)、与HAM A负相关(r=-0.36、-0.76,P0.05或P0.01)。Logistic回归分析显示,VSD与HAMD评分一致性与抑郁特征有关,焦虑躯体化因子得分较高的患者一致性较低(OR=0.87),而体重因子(OR=1.86)、日夜变化因子(OR=2.00)、绝望感因子(OR=1.13)得分高的患者一致性较高。结论:老年抑郁障碍患者对抑郁的主观体验与医师评估的严重程度一致性,在抑郁病情改善后相对发作期更高,提示抑郁症状特征与患者抑郁体验的自我认知有关。
[Abstract]:Objective: To compare the relationship between the subjective experience of depression and the clinical evaluation of the physician in the elderly with depression in different treatment stages, and to discuss the related factors. Methods:69 elderly patients who were enrolled in the tenth revision of the International Statistical Classification (ICD-10) for the diagnosis and depression of the disease and related health problems were followed up at baseline for 2 weeks,4 weeks and 52 weeks for 4 time points. The patient's self-assessment of the subjective experience of depression was completed with a depression visual scale (VSD), and the physician assessed the depression, anxiety and cognitive function of the patient with the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), and the Simple Mental State Checklist (MMSE). Results: The variance analysis of variance showed that the VSD scores at the end of the 2 and 4 weekends[(2.7% 1.6), (5.3% 2.0) vs. (7.0% 1.8), P0.001] increased, HAM D score[(36%11), (17%9) vs. (9%8), P0.001], as compared to the baseline. The scores of HAM A (27-10), (14-8) vs. (7-6), P.001],4-week and 52-week follow-up were not statistically significant (P0.05). There was no correlation between VSD score and HAMD and HAMA score at baseline and weekend, and there was a negative correlation between VSD and HAMD at 4 and 52 weeks (r =-0.31,-0.74, P0.05 or P0.01), and negative correlation with HAM A (r =-0.36,-0.76, P0.05 or P0.01). Logistic regression analysis showed that the consistency of VSD and HAMD was related to the characteristics of depression, the patients with higher scores of anxiety somatization factor were lower (OR = 0.87), while the body weight factor (OR = 1.86), the day-and-night change factor (OR = 2.00) and the sense of despair (OR = 1.13) were higher in the patients. Conclusion: The subjective experience of depression in the elderly patients with depression is consistent with the severity of the doctor's assessment, and the relative attack period after the improvement of the depression condition is higher, suggesting that the depressive symptoms are related to the self-cognition of the patient's depression experience.
【作者单位】：北京大学第六医院北京大学精神卫生研究所卫生部精神卫生学重点实验室(北京大学);江苏省淮安市第三人民医院;
【基金】：首都临床特色应用研究与成果推广项目(Z161100000516129)
【分类号】：R749.4

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