老年抑郁障碍患者的心理干预对比分析

目的 :探讨老年抑郁障碍心理干预的效果。方法 :采用对比研究的方法 ,在流行病学调查的基础上选择符合CCMD -Ⅱ -R诊断标准的 72例抑郁性神经症和 10例抑郁症患者 ,按性别、年龄、文化等基本相同 ,分成对照和实验组各一半 ,实验组给以 6周的心理干预 ,两组均不用药物治疗 ,分别于治疗前及三个月后 ,测评老年抑郁量表、生活满意度指数及社会支持评定量表 ,并进行对比分析。结果 :心理干预前两组老年抑郁量表 (SDS)得分分别为 17 41± 3 19、 17 5 1± 2 44,三个月后对照组下降不显著 ,而实验组明显下降 ( 17 5 1± 2 44/ 8 93± 5 5 2 ,t=10 89,P <0 0 0 1) ;生活满意度 (t=4 33,P <0 0 0 1)实验组显著提高 ;对照组无明显变化 ,社会支持评定实验组 ( 31 15± 6 37/ 36 32± 6 86 ,t =4 93,P <0 0 0 1)也显著提高 ,而对照组则不明显。结论 :社区综合性心理干预可改变抑郁性神经症患者的抑郁情绪 ,改善认知水平 ,从而提高生活满意度。     

居家养老老人睡眠质量对抑郁情绪的影响

目的:了解居家养老老人睡眠和抑郁状况,进一步考察老年人睡眠质量对抑郁情绪的影响作用。方法:采用匹兹堡睡眠质量指数量表(PSQI)和老年抑郁量表(GDS)对186名老年人进行问卷调查。结果:122.6%的老人存在睡眠障碍,其中女性比男性需要更长的时间入睡(t=-2.00,P0.05),高龄老人的睡眠总体情况明显比低龄老人差(t=2.85,P0.05),丧偶老人的睡眠效率比在婚的老人低(t=-2.81,P0.05);239.8%的老人有抑郁情绪,丧偶老人比在婚老人更易有抑郁情绪(t=-3.20,P0.005),受教育程度越高其抑郁情绪越低(F=5.246,P0.005);3PSQI总分与GDS总分显著正相关,日间功能障碍对老年抑郁有显著的预测作用,解释量达14.2%。结论:居家养老老人的睡眠质量与抑郁情绪呈显著负相关,睡眠质量对老年抑郁有一定的预测作用。     

健康教育与心理社会干预对2型糖尿病合并抑郁的影响

目的 :调查 2型糖尿病患者抑郁症状发生率并探讨健康教育及心理社会干预对抑郁症状及糖脂代谢的影响。方法 :采用Zung抑郁自评量表 (SDS)对 10 0例 2型糖尿病患者及 10 0例正常人群进行测评。将抑郁指数≥ 0 5的 5 9例患者随机分为研究组 30例 ,对照组 2 9例。研究组药物治疗的同时合并为期 3个月健康教育加心理社会支持治疗 ,分别于治疗前、治疗后进行抑郁自评量表及代谢控制水平评估。结果 :2型糖尿病并抑郁情绪检出率为 5 9% ,显著高于正常组 (P <0 0 1)。经健康教育加心理社会支持治疗 3个月后 ,观察组抑郁指数显著降低 (P <0 0 5 ) ,糖脂代谢显著改善 (P <0 0 5 )。抑郁转归发生率高 ,与对照组比较有极显著差异 (P <0 0 1)。结论 :2型糖尿病患者常合并忧郁症状 ,健康教育加心理社会支持治疗可改善抑郁症状及糖脂代谢     

综合性医院门诊就诊患者睡眠问题与情绪状态

目的:探讨综合性医院门诊就诊患者睡眠问题与情绪状态的相关关系。方法:采用睡眠问题测量问卷和中国心身健康量表,对483例门诊患者(研究组)和445例健康人群(对照组)进行问卷调查,数据应用t检验、Pearson相关分析、回归分析。结果:1综合性医院门诊就诊患者睡眠障碍总分及除非运动性异样睡眠因子外各因子分均高于健康人群(t=1.983~5.627,P0.05~0.01);2综合性医院门诊就诊患者睡眠障碍与焦虑、抑郁呈正相关(r=0.110~0.323,P0.05~0.01);3回归分析显示,影响综合性医院门诊就诊患者睡眠的主要因素是抑郁(β=0.264,t=5.997,P0.01)。结论:综合性医院门诊就诊患者总的睡眠质量相对较差;影响睡眠质量的主要因素是抑郁因子。     

住院精神分裂症患者病耻感与抑郁的关系

目的探讨住院精神分裂症患者病耻感与抑郁的关系。方法采用精神病患者病耻感评估量表、卡尔加里精神分裂症抑郁量表对77例住院精神分裂症患者进行问卷调查。结果精神分裂症患者的抑郁发生率为25.97%;不同受教育程度患者的病耻感总分及能力因子得分差异显著(P0.05);与抑郁总分相关性具有显著意义的变量包括:病耻感总分能力因子(r=0.39,0.35;P0.01),治疗因子(r=0.28,P0.05)。与抑郁体验因子相关性具有显著意义的变量包括:病耻感总分社交因子,能力因子(r=0.34,0.30,0.32;P0.01);与自我评价因子相关性具有显著意义的变量包括:病耻感总分社交因子(r=0.34,0.40;P0.01)。结论住院精神分裂症患者抑郁较常见,且病耻感越强,住院精神分裂症患者抑郁症状越明显。     

原发性肝癌患者抑郁症状与不成熟防御机制的关系

目的：了解原发性肝癌（PLC）患者的抑郁症状和不成熟防御机制（IDM）的水平，探讨PLC患者的抑郁症状与IDM的关系。方法：采用流调用抑郁自评量表（CES－D）和防御式方式问卷（DSQ）对PLC患者和健康组各100例进行调查。结果：1）PLC患者中49％可能或肯定有抑郁症状，其中23％肯定有抑郁症状，其发生率高于健康组；2）PLC组的CES－D总分高于健康组；3）PLC组比健康组采用较多分裂和潜意显现机制，采用较少抱怨机制；4）肯定有抑郁症状者比无抑郁症状者采用较多IDM；5）两组CES－D总分与IDM均分呈显著正相关，Pearson r为0.473-0.776，其中PLC组为0．473。结论：抑郁症状是PLC患者常见的负性情绪，医护人员应引起重视，并指导患者采用成熟的防御机制代替不成熟防御机制，预防并减轻患者的抑郁症状，以提高患者的生活质量。     

"后心梗抑郁"与AMI患者IL-6,CRP水平的关系

目的 :通过调查急性心肌梗死 (AMI)患者血浆白细胞介素 - 6 (IL - 6 ) ,C -反应蛋白 (CRP)与患者抑郁程度 (HADS -D评分 )之间的关系 ,探讨炎症反应在“后心梗抑郁”的产生及其在冠心病预示机制中的作用。方法 :5 8例AMI患者于入院时抽取外周静脉血 ,检测其发病 36小时以内血浆IL - 6、CRP水平 ;患者入院七天内完成标准化问卷调查表《医院情绪调查表—抑郁分表》(HADS -D)并计分 ,记录年龄、性别、冠心病危险因子及相关临床数据 ,包括心功能分级 (NYHA)、左室射血分数 (LVEF)、冠脉造影结果等。结果 :抑郁组AMI患者血浆IL - 6、CRP的水平显著高于非抑郁组 (0 .93± 0 .6 4vs 0 .4 8± 0 .37ng/L ,P <0 .0 5及 0 .96± 0 .4 1vs0 .4 7± 0 .2 6mg/dl,P <0 .0 5 )。患者的HADS -D评分、IL - 6水平与冠脉造影结果显示的动脉粥样硬化病变程度及LVEF不相关。结论 :AMI患者合并“后心梗抑郁”与患者体内炎性反应活跃有关。     

痴呆心境评定量表(DMAS)的信度和效度测定

目的 :分析痴呆心境评定量表 (DMAS)的信度和效度。方法 :3 0例符合CCMD -2 -R关于Alzheimer病或血管性痴呆诊断标准的病人 ,由临床医生是否存在抑郁症状判定为抑郁组 (16例 )和非抑郁组 (14例 )。 5位精神科医生参加评定 ,对 16例病人进行了联合评定 ,评定员之间一致性良好 ,ICC =0 87,F =13 5 44 ,P <0 0 1。 3 0例样本除接受DMAS评定外 ,同时接受汉密顿抑郁量表 (HAMD)、简易智力状态检查 (MMSE)、日常生活能力量表 (ADL)和大体痴呆评定量表 (GDS)的评定。结果 :抑郁组与非抑郁组的DMAS各单项分比较 ,共有 12个单项评分二组间有显著差异 (P <0 0 5或 <0 0 1)。单项分与剩余总分的相关系数 (rs)为 0 19～ 0 77,P均 <0 0 5或 <0 0 1,DMAS与HAMD的相关性良好 ,rs=0 68,P <0 0 1。因子分析结果 ,DMAS各项可归纳为 5个因子 ,分别为 :(1)情绪体验 (2 )焦虑 /抑郁 (3 )自我评价 (4 )活力缺乏 (5 )易激惹。项目的归类基本合理 ,具有临床可解释性 ,说明DMAS具有良好的结构效度。结论 :DMAS的信度与效度良好 ,项目设置适用于痴呆伴有抑郁的评价     

老年抑郁症的心理社会因素研究

目的:探讨老年抑郁症的心理社会因素.方法:按CCMD-3心境障碍抑郁发作诊断标准,收集33例60岁以上首次发作的患者(抑郁组),32名健康老年人(对照组).采用生活事件量表、艾森克问卷、简易智力状态检查表和社会支持评定量表等,进行测评分析.结果:抑郁组与对照组精神疾病家族史(分别为5例/0例,χ2=5.253,P=0.022)、现患躯体疾病(16例/6例,χ2=6.415,P=0.011)、血管危险因素(10例/3例,χ2=4.447,P=0.035)和长期困境(19例/3例,χ2=14.437,P=0.000)的差异有显著性,而抑郁组MMSE总分26.2±2.3低于对照组27.3±0.8(t=2.552,P=0.015).抑郁组负性生活事件分值17.9±15.0低于对照组10.7±7.8(t=2.42,P=0.019);抑郁组社交问题分值3.5±6.9高于对照组1.2±3.8(u=1.982,P=0.047).抑郁组社会支持总分39.5±6.8低于对照组42.9±4.2(t =2.434,P=0.018);抑郁组对支持的利用度5.9±2.7低于对照组8.4±1.6(u=3.844,P=0.000).抑郁组神经质分60.0±8.8高于对照组51.7±4.9(t=4.737,P=0.000);抑郁组与对照组的神经质个性(24例/3例,χ2=26.851,P=0.000)的差异有显著性.结论:慢性应激、高度神经质和认知功能损害严重是老年抑郁症的重要危险因素.     

老年抑郁与生活事件、社会支持的对照研究

采用生活事件量表,社会支持问卷及 EPQ 问卷对社区中抑郁状态老人及正常老人进行对照研究,结果表明,老年抑郁组的生活事件发生率(92.4%)明显高于对照组(44.3%)(X~2=40.056。P<0.001)。生活事件中以重病外伤居多(52人,占71.23%)。其次为夫妻严重争执及家庭成员纠纷(22人,占30.14%)。老年抑郁组的社会支持总分平均为8.09±3.994分,明显低于对照组的11.8±3.976分,(T=5.85,P<0.001)。而 EPQ 结果两组间差异无显著性。结果提示,生活事件与老年抑郁的发生密切相关,重大生活事件发生越多,且缺乏较好的社会支持,老年抑郁发生的可能就越大。     

超高龄老年人慢性阻塞性肺疾病与抑郁症状的关系及失能的中介作用

目的:探讨超高龄老年人慢性阻塞性肺疾病(COPD)患病与抑郁症状的关联并分析日常生活失能的中介作用。方法:采用2018年中国老年健康影响因素跟踪调查(CLHLS)数据,纳入90岁以上的超高龄老年人4898例,其中男性1861例(38.0%),女性3037例(62.0%)。用流调中心用抑郁量表简版(CES-D-10)和日常活动能力量表(ADL)评估抑郁症状和日常生活自理能力。根据既往病史判断COPD患病情况。结果:共有COPD患病者549例(11.2%)。超高龄老年人群CES-D-10评分中位数为7分(0,30),抑郁症状的阳性检出446例(9.1%),日常生活失能者共2096例(42.8%)。COPD患病者的抑郁症状阳性的检出率高于COPD未患病者(12.4%vs.8.7%,P<0.001),失能率高于COPD未患病者(52.3%vs.41.6%,P<0.01)。中介效应检验结果显示,COPD对抑郁症状的直接效应占总效应量的81.2%,失能在COPD与抑郁的关联中具有明显的中介效应,中介效应占总效应量的18.8%。结论:失能在超高龄老年人COPD患病与抑郁的相关关系中起部分...     

The impact of dementia on the detection of depression in elderly subjects from the general population

BACKGROUND: The performance of the CES-D in a sample of elderly community residents was assessed. The influence of dementia on test performance and the necessity for the use of four factor scores instead of a single summary score of the CES-D were studied. METHOD: Two hundred and eighty-seven subjects out of the general population aged 60-99 years were personally interviewed with standardized diagnostic tools and completed the CES-D. Best-estimate diagnoses served as 'gold standards' for receiver operating characteristics (ROC) analysis. RESULTS: The CES-D discriminated well between depressive and non-depressive subjects. Exclusion of demented subjects from the sample did not markedly increase test performance. Current depressive illness and dementia led to high scores on the CES-D. Unlike the factors 'depressive affect', 'somatic/vegetative complaints', and 'interpersonal relations', the factor' positive affect' of the CES-D discriminated well between demented and non-demented participants. CONCLUSIONS: The CES-D is a valid instrument for screening for depression in a community sample of elderly subjects. Its use can be recommended even if the presence of dementia is likely. The use of factor scores of the CES-D does not substantially contribute to an improvement of overall test performance, but, nevertheless, allows a more detailed insight and better interpretation of test results.     

Stability and change in level of maternal depressive symptomatology during the first postpartum year

BACKGROUND: This study evaluated stability and change in the level of maternal depressive symptomatology over the course of the first postpartum year in a community cohort of 106 first-time mothers of full-term, healthy infants. Effects of diagnosed depression and infant gender were also assessed. METHODS: At 2 months postpartum (intake), mothers were classified into one of two symptom groups on the basis of their total score on the Center for Epidemiological Studies-Depression Scale (CES-D): high (CES-D score > or = 16, 46%) or normative (CES-D score = 2-12, 54%). Mothers completed the CES-D again at 3, 6, and 12 months postpartum. At 12 months, maternal diagnostic status for major depression and related disorders was evaluated using the Diagnostic Interview Schedule-III-Revised. RESULTS: Mothers in the High symptom group at intake continued to have significantly higher CES-D scores at 3, 6, and 12 months than mothers in the Normative symptom group at intake, and a third in the High symptom group at intake had a subsequent CES-D score above the clinical cutoff (> or = 16). Maternal CES-D scores were significantly correlated across visits. In regressions controlling for diagnostic status and infant gender, mothers' CES-D score at the most recent prior assessment contributed significant unique variance to mothers' CES-D score at each subsequent assessment. CES-D scores were higher at 3 months if mothers had diagnosed depression and were parenting a son, and higher at 12 months if mothers had both diagnosed depression and a prior, high CES-D score. LIMITATIONS: Findings may not generalize to multipara or high-risk cohorts. CONCLUSIONS: First-time mothers with high levels of depressive symptomatology at 2 months postpartum (especially those with diagnosed depression) are at increased risk of continuing to experience high levels of depressive symptomatology throughout the first postpartum year. Implications for preventative intervention services are discussed.     

腔隙性服梗塞病人的焦虑和抑郁评定

目的　评定腔隙性脑梗塞病人的焦虑和抑郁。方法　病人于住院 1周时评定抑郁量表 ( HAMD)、抑郁自评量表( CES-D)和焦虑量表 ( HAMA) ,并与正常对照比较。结果　病人 HAMD总分 ( 8.2 3± 5.58分 )与对照组 ( 7.63± 3.4 2分 )无显著差异 ;CES-D总分 ( 1 6.2± 9.67分 )比对照组 ( 8.2 3± 7.75分 )显著为高 ;HAMA总分 ( 5.93± 3.83分 )与对照组( 5.94± 4 .1 1分 )无显著差异。结论　腔隙性脑梗塞病人存在不足综合征的抑郁 ;用 CES-D比用 HAMD更易检出不足综合征的抑郁 ;腔隙性脑梗塞病人在住院 1周时未检出明显焦虑。     

The impact of depressive symptoms on the functional status of inner-city patients with asthma.

BACKGROUND: Functional deficits are common in patients with asthma. If there is cooccurring depression, these deficits may be more severe and/or more persistent. OBJECTIVE: This study was undertaken to determine 1) the prevalence and severity of depressive symptoms in a sample of inner-city patients being treated for asthma and 2) the impact of these symptoms on functional status. METHODS: Three hundred seventeen enrollees in an inner-city asthma program were evaluated using the health status questionnaire and the Center for Epidemiologic Studies Depression Scale (CES-D) at baseline and at 3- and 6-month follow-ups. Two groups were created based on patients' CES-D baseline scores, using a commonly used cutpoint to define "caseness" for depression. The two groups were compared using ANOVA, chi2, and the general linear model for repeated measures. RESULTS: Of the sample, 55.01% had a CES-D score greater than the cutpoint for depression. The mean was 29.3 +/- 11.95, well above the scores commonly used to indicate the presence of depression. The depressed group had lower scores on many measures of functional capacity at baseline; whereas both depressed and nondepressed patients improved over time on the physical performance measure (the physical performance measure subscale of the health status questionnaire), the mean score for the depressed group was consistently lower. CONCLUSIONS: The prevalence of depressive symptoms was greater than expected. Depression was persistent and had a major impact on functional capacity. Routine depression screening may be especially important in inner-city patients and other groups thought to be at increased risk for poor outcome.     

Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO study. Functional status,health service use and treatment of people with depressive symptoms

BACKGROUND: Screening surveys of depressive symptoms were conducted among primary care patients at six sites in different countries. The LIDO Study was designed to assess quality of life and economic correlates of depression and its treatment in culturally diverse primary health care settings. This paper describes: (1) the association between depressive symptoms and functional status, global health-related quality of life (QoL), and use of general health services across different cultural settings; and (2) among subjects with depressive symptoms, the factors associated with recent treatment for depression. METHODS: Subjects aged 18 to 75 were recruited from participating primary care facilities in Be'er Sheva (Israel), Porto Alegre (Brazil), Melbourne (Australia), Barcelona (Spain), St Petersburg (Russian Federation) and Seattle (USA). Depressive symptoms were measured using the CES-D. Also administered were the SF-12, global questions on QoL, selected demographic and social measures, and questions on recent treatment for depression, use of health care services, and lost workdays. RESULTS: A total of 18,489 patients were screened, of whom 37% overall (range 24-55%) scored > or = 16 on the CES-D and 28% (range 17-42%) scored > or = 20. Overall, 13% reported current treatment for depression (range 4 to 23%). Patients with higher depressive symptom scores had worse health, functional status, QoL, and greater use of health services across all sites. Among those with a CES-D score > or = 16, subjects reporting treatment for depression were more likely than those reporting no treatment to be dissatisfied with their health (except in St Petersburg), and to have higher depressive symptom scores. CONCLUSIONS: Higher depressive symptom scores in primary care patients were consistently associated with poorer health, functional status and QoL, and increased health care use, but not with demographic variables. The likelihood of treatment for depression was associated with perceptions of health, as well as severity of the depression.     

成都、德阳地区地震8个月后老年人抑郁状况及其相关因素

目的:评估汶川地震8个月后,成都、德阳灾区老年人的抑郁状况及其相关因素。方法:按照方便取样原则,利用自编地震后受灾群众基本情况调查表、流调中心抑郁量表调查了成都、德阳两地390名受灾老年人。结果:9.8%的老年人有疑似抑郁症状,30.3%的老年人有抑郁症状。两地老年人的抑郁状况受性别、教育程度、居住地、职业以及地震期间经历的影响。Logistic回归分析表明,与男性、初中教育程度、以前无可怕经历、地震中害怕/无助/恐怖的感觉不强烈的老年人相比,女性(OR=2.03)、小学以下教育程度(OR=2.59)、以前有可怕经历(OR=2.06)、地震中害怕/无助/恐怖的感觉强烈(OR=1.59)的老年人的抑郁状况更严重。结论:成都、德阳地区老年人,在地震8个月后的抑郁状况仍然比较严重。灾后心理干预要特别关注女性、教育程度低、仍从事农业劳动、受灾较重老年人的抑郁状况。     

Depression in women with polycystic ovary syndrome: clinical and biochemical correlates

BACKGROUND: We assessed the prevalence of mood disturbance among women with prospectively documented polycystic ovary syndrome (PCOS). METHODS: Thirty-two women with PCOS completed the Center for Epidemiological Studies-Depression Rating Scale (CES-D). Clinical and biochemical characteristics were assessed. RESULTS: Sixteen women had CES-D scores indicative of depression. Depression was associated with greater insulin resistance (P=0.02) and higher body mass index (P=0.05). Women receiving oral contraceptives for the treatment of PCOS were less depressed than patients not receiving treatment (P=0.03). LIMITATIONS: Possible selection bias, use of a screening tool alone without further diagnostic evaluation of depression, small samples size and lack of direct comparison with an age matched control group, should be considered in interpretation of these results. CONCLUSION: Findings suggest a high prevalence of depression among women with PCOS, and an association between depression and PCOS markers.     

成都地区55周岁及以上人群中抑郁症患病率调查

目的了解成都地区55周岁及以上人群中抑郁症患病率及其影响因素。方法本文采用分层随机整群抽样方法,从成都市所辖地区抽取10个区市县。按农业人口和非农业人口所占比例确定应查城乡55周岁及以上人口数。调查由两阶段组成,先用流调用抑郁自评量表(CES-D)筛查,然后用DSM-Ⅲ-R定式临床检查(SCID-P)进行诊断复查。应查5587人,实查5385人,其中5350人完成了CES-D检查,35人因耳聋(且不识字),失语无法完成CES-D,改用SCID-P询问家属或其他知情者。外出171人,拒查31人,漏查率3.6%。结果发现CES-D评分≥16分者168人,为被调查人口的3.14%。诊断复查发现各类抑郁症的患病率分别为适应性障碍0.85%。心境恶劣障碍0.76%,躯体疾病所致抑郁心境0.52%,重型抑郁症0.45%。各类抑郁症总患病率为2.62%,其中男性1.60%,女性3.54%,女性患病率显著高于男性。多元逐步回归分析表明日常生活能力受损、女性以及认知功能下降老人有抑郁症状者较多。结论本文结果表明我国抑郁症患病率较低。适应性障碍,心境恶劣障碍和躯体疾病引起的抑郁是主要的抑郁类型。