D型人格对老年人抑郁情绪的影响机制:社会支持和心理弹性的中介作用

目的 研究D型人格对老年人抑郁情绪的影响以及社会支持和心理弹性在二者之间的作用。方法 选择2019年5月至2020年10月中国人民解放军总医院第一医学中心心内科门诊、神经内科门诊和心理科门诊就诊的208例≥60岁的老年患者为研究对象。采用抑郁情绪自评量表(PHQ-9)、心理弹性量表(CD-RISC)、社会支持评定量表(SSRS)、D型人格量表(DS14)及简明国际神经精神访谈中文版(MINI)进行D型人格特征和抑郁情绪调查。采用SPSS 23.0统计软件进行数据分析。使用Pearson相关分析D型人格特征与心理弹性、社会支持和抑郁情绪的相关性,若存在相关则进一步采用Process插件分析社会支持和心理弹性在D型人格和抑郁情绪中的中介效应,并用Bootstrap法检验中介作用是否有统计学意义。结果 208例研究对象中,D型人格组患抑郁障碍的风险是非D型人格组的4.18倍(95%CI 2.01~8.69)。D型人格可直接影响抑郁情绪,直接效应值为3.83(95%CI 1.60~6.06)。D型人格可通过社会支持和心理弹性的中介作用调节抑郁情绪,中介效应值为1.92(95%CI 0.97~3.06)。具体来看,中介效应主要由三部分组成:通过D型人格特征-社会支持-抑郁情绪途径产生中介效应(效应值是0.86,95%CI 0.24~1.73)；通过D型人格特征-心理弹性-抑郁情绪途径产生中介效应(效应值是0.81,95%CI 0.19~1.62)；通过D型人格特征-社会支持-心理弹性-抑郁情绪途径产生中介效应(效应值是0.25,95%CI 0.05~0.55)。结论 D型人格是老年人抑郁障碍的危险因素。D型人格影响抑郁情绪的机制包括两个部分,一是直接效应,二是通过社会支持/心理弹性/社会支持-心理弹性的中介作用调节抑郁情绪。

Influence mechanism of type D personality on depression in the elderly:mediat-ing role of social support and psychological resilience

Objective To determine the effect of type D personality on depression in the elderly and investigate the role of social support and resilience between them. Methods A total of 208 elderly patients aged 60 and above admitted in the outpatient Departments of Cardiology, Neurology and Psychology of the First Medical Center of Chinese PLA General Hospital were recruited in this study. Patient health questionnaire(PHQ-9), Connor-Davidson resilience scale (CD-RISC), social support rating scale(SSRS), type D personality scale-14(DS14) and mini-international neuropsychiatric interview(MINI) were used to investigate type D personality characteristics and depression. The data was analyzed with SPSS statistics 23.0. Pearson correlation analysis was used to analyze the correlation of type D personality, resilience, social support and depression. For the correlation, process Plug-in was applied to analyze the mediating effect of social support and resilience in type D personality and depression, and Bootstrap method was adopted to test whether the mediating effect was statistically significant. Results Among the total of 208 subjects, the risk of depressive disorder of subjects with type D personality was 4.18 times higher than that of those without (95% CI 2.01-8.69). Type D personality could directly affect depressive symptoms, with a direct effect value of 3.83 (95% CI 1.60-6.06). Type D personality could regulate depression through social support and psychological resilience, with a mediating effect value of 1.92 (95% CI 0.97-3.06). Specifically, the mediating effect was mainly composed of 3 parts:the mediating effect value of type D personality-social support-depression was 0.86 (95% CI 0.24-1.73); type D personality-resilience-depression was 0.81 (95% CI 0.19-1.62), and that of type D personality-social support-resilience-depression was 0.25 (95% CI 0.05-0.55). Conclusion Type D personality is a risk factor for depression in the elderly. Its mechanism includes 2 parts, direct effect and mediating effects of social support/resilience/social support-resilience.