摘要
目的调查中国急性期治疗有效的抑郁症患者残留躯体症状的发生率与特点及其对生活质量、社会功能的影响。方法本研究为多中心横断面研究,调查对象为中国11家医院的精神科门诊抑郁症患者共1 503例,急性期抗抑郁药治疗8~12周后且视觉模拟量表评定病情较治疗前恢复≥50%,根据16项抑郁症状快速评估量表(Brief 16-item Quick Inventory of Depressive Symptomatology Self-Report,QIDS-SR16)总分将患者分为残留组(QIDS-SR16>5分)和痊愈组(QIDS-SR16≤5分)。采用QIDS-SR16、健康问卷躯体症状群量表(Patient Health Questionnaire-15,PHQ-15)、简明幸福与生活质量满意度问卷(Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form,Q-LES-Q-SF)、席汉残疾量表(Sheehan Disability Scale,SDS)评估抑郁症状、躯体症状、生活质量与社会功能,并进行组间比较,分析生活质量和社会功能的相关因素。结果49.8%(748/1 503)的患者残留有躯体症状群(PHQ-15>4分);常见躯体症状(PHQ-15≥1分)包括疲乏(56.3%,846/1 503),睡眠问题(50.6%,760/1 503)、头痛(43.6%,655/1 503),便秘、稀便或腹泻(41.3%,620/1 503),心脏砰砰跳动感(37.6%,565/1 503),眩晕(34.0%,511/1 503),恶心、胀气消化不良(33.6%,505/1 503)等。残留组有躯体症状群(PHQ-15>4分)患者为75.7%(555/733),高于痊愈组的25.1%(193/770;χ^2=385.38,P<0.01),其社会功能(t=2.77~10.47)和生活质量(t=3.04~11.41)较痊愈组差,组间差异均有统计学意义(均P<0.01)。广义线性回归分析显示,性别(女性)、首次发作病史与社会功能相关,且与社会功能和生活质量有关的因素还包括抑郁残留症状、不同程度躯体症状、伴随躯体疾病、年龄、本次发作抗抑郁药治疗时长。结论急性期治疗主观感觉有效的抑郁症患者残留躯体症状群发生率较高,残留躯体症状越重生活质量与社会功能越差,提示达临床痊愈还需更加重视躯体症状。
Objective To investigate the prevalence and characters of residual physical symptoms in Chinese depressive patients after acute treatment and the influence on the quality of life and social function.Methods In the multi-centers cross-sectional study, 1 503 adult depressive outpatients, from 11 hospitals, who had been treated by antidepressants for 8—12 weeks with significant improvement of at least 50% by Self-rating Visual Analog Scale were involved. The group with residual physical symptoms could be differentiated by Brief 16-Item Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR16) >5, while the QIDS-SR16 of remission group was ≤5. The QIDS-SR16, Patient Health Questionnaire-15 (PHQ-15), Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) and Sheehan Disability Scale (SDS) were used to assess the depressive symptoms, physical symptoms and social function.Results 49.8% (748/1 503) patients had residual physical symptoms (PHQ-15>4). The most common physical symptoms (PHQ-15≥1) were feeling tired or having low energy (56.3%, 846/1 503), trouble sleeping (50.6%, 760/1 503), headache(43.6%, 655/1 503), constipation, loose stools or diarrhea(41.3%,620/1 503), feeling heart pound or race (37.6%,565/1 503), dizziness (34.0%,511/1 503), nausea, gas or indigestion (33.6%,505/1 503), etc. The 75.7% (555/733) of the physical symptoms (PHQ-15>4) in residual group was significantly higher than the 25.1% (193/770;χ^2=385.38, P<0.01) in remission group. The differences on social function (t=2.77-10.47) and life quality (t=3.04-11.41) between two groups were significant (P<0.01). Generalized linear regression analysis showed that gender (female), present history of first episode were related to better social function, and the factors related to both social function and quality of life included residual depressive symptoms, residual physical symptoms of different severity, comorbid medical conditions, age, duration of antidepressant treatment for this episode.Conclusion The rate of residual physical symptoms is higher in patients with major depression who responded to acute phase treatment. The more severe the residual physical symptoms, the worse the quality of life and social function. It suggests that physical symptoms be focused in order to achieve clinical recovery.
作者
张旭
冯威
王刚
胡永东
牛雅娟
胡建
王学义
高成阁
张宁
方贻儒
黄继忠
刘铁榜
贾福军
吴文源
Zhang Xu;Feng Wei;Wang Gang;Hu Yongdong;Niu Yajuan;Hu Jian;Wang Xueyi;Gao Chengge;Zhang Ning;Fang Yiru;Huang Jizhong;Liu Tiebang;Jia Fujun;Wu Wenyuan(Department of Psychiatry,Tongji Hospital of Tongji University,Shanghai 200065,China;Shenzhen Kangning Hospital, Shenzhen 518020,China;Guangdong Mental Health Center,Guangzhou 510080,China;National Clinical Research Center for Mental Disorders,Beijing ,Anding Hospital,Capital Medical University,Beijing 100088, China;Department of Clinical Psychology,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China;Department of Psychiatry,Beijing HuiLongGuan Hospital,Beijing 100096, China;Department of Psychiatry,the First Affiliated Hospital of Harbin Medical University,Harbin 150001, China;Department of Psychiatry,the First Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Psychiatry,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Psychiatry, Affiliated Brain Hospital of Nanjing Medical University,Nanjing 210029,China;Division of Mood Disorders, Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2019年第1期76-81,共6页
Chinese Journal of Psychiatry
关键词
抑郁症
治疗结果
生活质量
身体症状
社会功能
Depressive disorder
Treatment outcome
Quality of life
Physical symptoms
Social function
作者简介
通信作者:吴文源,Email:wuwy@tongji.edu.cn.
