老年慢性疼痛病人初诊时焦虑抑郁状况及其影响因素分析
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摘要
目的探讨老年慢性疼痛病人初诊时焦虑抑郁状况,并对相关影响因素进行分析,为相关干预措施的制定提供参考。方法采用一般资料调查表、视觉模拟评分法(VAS)、焦虑自评量表及抑郁自评量表对2017年1—8月于我院疼痛科住院的219例病人进行调查分析。结果 219例病人中抑郁者65例(29.7%),焦虑者78例(35.6%),同时患有焦虑和抑郁者48例(21.9%),病人焦虑和抑郁状态呈正相关关系(r=0.51,P<0.05)。多因素Logistic回归分析显示,年龄70～79和≥80岁者(OR=0.51,95%CI=0.16～0.92,P<0.05,OR=0.58,95%CI=0.13～0.75,P<0.05)、已婚者(OR=0.59,95%CI=0.13～0.81,P<0.05)、最近1个月未发生睡眠障者(OR=0.42,95%CI=0.09～0.91,P<0.05)较少出现抑郁状态,而BMI>28kg/m2者(OR=1.43,95%CI=1.03～2.83,P<0.05)、VAS>7分者(OR=3.40,95%CI=1.06～9.57,P<0.05)、疼痛史1～3和>3年者(OR=3.73,95%CI=1.24～11.99,P<0.05;OR=3.29,95%CI=1.06～12.47,P<0.05)更容易出现抑郁状态。已婚者(OR=0.78,95%CI=0.13～0.91,P<0.05)、最近1个月未发生睡眠障者(OR=0.24,95%CI=0.03～0.84,P<0.05)较少出现焦虑状态,而VAS>7分者(OR=2.30,95%CI=1.06～6.57,P<0.05)、疼痛分组为复杂性疼痛者(OR=2.41,95%CI=1.31～7.51,P<0.05)、疼痛史1～3和>3年者(OR=2.73,95%CI=1.24～5.99,P<0.05,OR=2.29,95%CI=1.06～6.47,P<0.05)更容易出现焦虑状态。结论老年慢性疼痛病人易伴发焦虑、抑郁症状,医师在临床诊疗时需关注这些易导致焦虑、抑郁的因素,治疗慢性疼痛的同时应对病人予以心理或药物干预,以更好控制疼痛。
Objective To investigate anxiety and depression in elderly patients with chronic pain at initial diagnosis and related influencing factors,and to provide a reference for developing related intervention measures. Methods A total of 219 patients who were hospitalized in Department of Pain Management in our hospital from January to August,2017 were enrolled,and ageneral information questionnaire,Visual Analogue Scale(VAS),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used for investigation and analysis. Results Among the 219 patients,65(29.7%)had depression,78(35.6%)had anxiety,and 48(21.9%)had both depression and anxiety;anxiety was positively correlated with depression in these patients(r=0.51,P<0.05).The multivariate logistic regression analysis showed that the patients with an age of 70-79,and≥80 years(OR=0.51,95%CI=0.16-0.92,P<0.05;OR=0.58,95%CI=0.13-0.75,P<0.05),who were married(OR=0.59,95%CI=0.13-0.81,P<0.05),or who did not experience sleep disorder within the past one month(OR=0.42,95%CI=0.09-0.91,P<0.05)had a lower risk of depression,while the patients with a body mass index of>28 kg/m2(OR=1.43,95%CI=1.03-2.83,P<0.05),a VAS score of>7(OR=3.40,95%CI=1.06-9.57,P<0.05),or a duration of pain of 1-3,and >3 year(OR=3.73,95%CI=1.24-11.99,P<0.05;OR=3.29,95%CI=1.06-12.47,P<0.05)were more likely to suffer from depression.The patients who were married(OR=0.78,95%CI=0.13-0.91,P<0.05)or who did not experience sleep disorder within the past one month(OR=0.24,95%CI=0.03-0.84,P<0.05)had a lower risk of anxiety,while the patients with a VAS score of>7(OR=2.30,95%CI=1.06-6.57,P<0.05),complex pain(OR=2.41,95%CI=1.31-7.51,P<0.05),or a duration of pain of 1-3,and>3 year(OR=2.73,95%CI=1.24-5.99,P<0.05;OR=2.29,95%CI=1.06-6.47,P<0.05)were more likely to suffer from anxiety. Conclusion Elderly patients with chronic pain tend to develop depression and anxiety.Physicians should pay attention to the factors which may lead to anxiety and depression in clinical diagnosis and treatment,and psychological or pharmaceutical interventions should be given during the treatment of chronic pain,so as to control the pain better.
Objective To investigate anxiety and depression in elderly patients with chronic pain at initial diagnosis and related influencing factors,and to provide a reference for developing related intervention measures. Methods A total of 219 patients who were hospitalized in Department of Pain Management in our hospital from January to August,2017 were enrolled,and ageneral information questionnaire,Visual Analogue Scale(VAS),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)were used for investigation and analysis. Results Among the 219 patients,65(29.7%)had depression,78(35.6%)had anxiety,and 48(21.9%)had both depression and anxiety;anxiety was positively correlated with depression in these patients(r=0.51,P<0.05).The multivariate logistic regression analysis showed that the patients with an age of 70-79,and≥80 years(OR=0.51,95%CI=0.16-0.92,P<0.05;OR=0.58,95%CI=0.13-0.75,P<0.05),who were married(OR=0.59,95%CI=0.13-0.81,P<0.05),or who did not experience sleep disorder within the past one month(OR=0.42,95%CI=0.09-0.91,P<0.05)had a lower risk of depression,while the patients with a body mass index of>28 kg/m2(OR=1.43,95%CI=1.03-2.83,P<0.05),a VAS score of>7(OR=3.40,95%CI=1.06-9.57,P<0.05),or a duration of pain of 1-3,and >3 year(OR=3.73,95%CI=1.24-11.99,P<0.05;OR=3.29,95%CI=1.06-12.47,P<0.05)were more likely to suffer from depression.The patients who were married(OR=0.78,95%CI=0.13-0.91,P<0.05)or who did not experience sleep disorder within the past one month(OR=0.24,95%CI=0.03-0.84,P<0.05)had a lower risk of anxiety,while the patients with a VAS score of>7(OR=2.30,95%CI=1.06-6.57,P<0.05),complex pain(OR=2.41,95%CI=1.31-7.51,P<0.05),or a duration of pain of 1-3,and>3 year(OR=2.73,95%CI=1.24-5.99,P<0.05;OR=2.29,95%CI=1.06-6.47,P<0.05)were more likely to suffer from anxiety. Conclusion Elderly patients with chronic pain tend to develop depression and anxiety.Physicians should pay attention to the factors which may lead to anxiety and depression in clinical diagnosis and treatment,and psychological or pharmaceutical interventions should be given during the treatment of chronic pain,so as to control the pain better.
引文
[1]李春蕊,张雯,樊碧发.数字评分法(NRS)与口述评分法(VRS)在老年慢性疼痛病人中的比较[J].中国疼痛医学杂志,2016,22(9):683-686.
[2]张天燕,刘小立,杨娟丽.老年癌症患者疼痛和社会心理状况的调查研究[J].中国疼痛医学杂志,2015,21(6):474-476.
[3]冯晨秋,高晖,王贞慧,等.济南市社区老年慢性疼痛患者生活质量影响因素的分析[J].中国疼痛医学杂志,2013,19(4):216-219.
[4]闻洁曦,邢国刚.慢性疼痛与抑郁关系的研究进展[J].中国疼痛医学杂志,2012,18(7):436-440.
[5]刘宇,史铁英,姜桐桐.慢性疼痛患者疼痛信念的研究进展[J].中国护理管理,2018,18(11):1549-1553.
[6]刘义,高静芳.抑郁与慢性疼痛相关的神经生物学共同机制研究进展[J].精神医学杂志,2010,23(2):155-157.
[7]陈国良,王梅,路桂军,等.慢性疼痛患者焦虑、抑郁状况调查及相关因素分析[J].中国疼痛医学杂志,2014,20(4):226-230,235.
[8]DE LA VEGA R,GROENEWALD C,BROMBERG M H,et al.Chronic pain prevalence and associated factors in adolescents with and without physical disabilities[J].Dev Med Child Neurol,2018,60(6):596-601.
[9]白雪,郭蕾蕾.老年慢性疼痛患者自我效能与自我护理能力的相关性研究[J].解放军预防医学杂志,2017,35(6):674-677.
[10]嵇承栋,付强强,杨志萍,等.慢性疼痛社区流行病学调查的研究进展[J].中国疼痛医学杂志,2018,24(7):542-547.
[11]张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005:213.
[12]郭筱华,陈丁慧,周敏,等.中老年人睡眠障碍与慢性病关系分析[J].中华保健医学杂志,2012,14(1):44-45.
[13]朱薇,贾东林,刘晓光,等.慢性腰腿痛住院患者焦虑抑郁状态及其对疼痛的影响[J].中国疼痛医学杂志,2017,23(3):200-204.
[14]VANHAUDENHUYSE A,GILLET A,MALAISE N,et al.Psychological interventions influence patients’attitudes and beliefs about their chronic pain[J].J Tradit Complement Med,2017,8(2):296-302.
[15]SANDWEISS A J,COTTIER K E,MCINTOSH M I,et al.17-β-Estradiol induces spreading depression and pain behavior in alert female rats[J].Oncotarget,2017,8(69):114109-114122.
[16]LI J,CHEN J,QIN Q,et al.Chronic pain and its association with obesity among older adults in China[J].Arch Gerontol Geriatr,2018,76:12-18.
[17]RUSU A C,PINCUS T.Chronic pain patients’perceptions of their future:A verbal fluency task[J].Pain,2017,158(1):171-178.
[18]黄琳,刘琴,杨丽萍,等.社区疼痛老年人慢性疼痛体验及其影响因素研究[J].中国卫生工程学,2018,17(1):69-71.
[19]陈培莲.关注老年慢性疼痛患者[J].老年医学与保健,2018,24(5):564-566.
[20]孟文君,魏昕,柴小青,等.急性、慢性疼痛病人的痛阈及焦虑状态的比较[J].中国疼痛医学杂志,2018,24(1):40-44.
[21]贺永进,吕丹,王准,等.慢性疼痛治疗现状[J].中国现代神经疾病杂志,2018,18(10):703-704.
[22]TRAN P,STURGEON J A,NILAKANTAN A,et al.Pain catastrophizing mediates the relationship between trait happiness and depressive symptoms in individuals with current pain[J].J Appl Biobehav Res,2017,22(4):e12609.
[23]江倩倩,贾泽娟,张昭,等.心理干预改善慢性疼痛的研究进展[J].齐鲁护理杂志,2018,24(15):100-102.
[24]杨向东.心理干预对慢性疼痛患者社会心理状态的影响[J].临床研究,2018,26(7):184-185.
[25]宋春燕,吴红艳,戴红梅,等.慢性疼痛门诊患者心理体验的现象学研究[J].护理学杂志,2017,32(23):81-84.
[26]刘倩,李小霞,黄旭,等.慢性疼痛对社区老年人身心健康的影响[J].北京医学,2017,39(11):1186-1187.
[27]蔡宏澜,段宝霖,王雅,等.慢性疼痛病人伴发焦虑、抑郁和躯体化症状的现况分析[J].中国疼痛医学杂志,2017,23(10):788-790.
[28]DOROUDI T,KOLIVAND P,DIVANBEIGI A,et al.Comparing diagnostic accuracy of direct questioning versus schematic evaluation of chronic pain localization[J].Acta Clin Croat,2017,56(4):689-697.
[29]赵昍朋,张媛,张柏宁.慢性疼痛与抑郁的研究进展[J].内蒙古医科大学学报,2017,39(4):386-389.
[30]施华,马世龙,潘兰霞.慢性疼痛对老年人日常生活影响及应对方式调查[J].中医临床研究,2016,8(32):114-116.
[2]张天燕,刘小立,杨娟丽.老年癌症患者疼痛和社会心理状况的调查研究[J].中国疼痛医学杂志,2015,21(6):474-476.
[3]冯晨秋,高晖,王贞慧,等.济南市社区老年慢性疼痛患者生活质量影响因素的分析[J].中国疼痛医学杂志,2013,19(4):216-219.
[4]闻洁曦,邢国刚.慢性疼痛与抑郁关系的研究进展[J].中国疼痛医学杂志,2012,18(7):436-440.
[5]刘宇,史铁英,姜桐桐.慢性疼痛患者疼痛信念的研究进展[J].中国护理管理,2018,18(11):1549-1553.
[6]刘义,高静芳.抑郁与慢性疼痛相关的神经生物学共同机制研究进展[J].精神医学杂志,2010,23(2):155-157.
[7]陈国良,王梅,路桂军,等.慢性疼痛患者焦虑、抑郁状况调查及相关因素分析[J].中国疼痛医学杂志,2014,20(4):226-230,235.
[8]DE LA VEGA R,GROENEWALD C,BROMBERG M H,et al.Chronic pain prevalence and associated factors in adolescents with and without physical disabilities[J].Dev Med Child Neurol,2018,60(6):596-601.
[9]白雪,郭蕾蕾.老年慢性疼痛患者自我效能与自我护理能力的相关性研究[J].解放军预防医学杂志,2017,35(6):674-677.
[10]嵇承栋,付强强,杨志萍,等.慢性疼痛社区流行病学调查的研究进展[J].中国疼痛医学杂志,2018,24(7):542-547.
[11]张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005:213.
[12]郭筱华,陈丁慧,周敏,等.中老年人睡眠障碍与慢性病关系分析[J].中华保健医学杂志,2012,14(1):44-45.
[13]朱薇,贾东林,刘晓光,等.慢性腰腿痛住院患者焦虑抑郁状态及其对疼痛的影响[J].中国疼痛医学杂志,2017,23(3):200-204.
[14]VANHAUDENHUYSE A,GILLET A,MALAISE N,et al.Psychological interventions influence patients’attitudes and beliefs about their chronic pain[J].J Tradit Complement Med,2017,8(2):296-302.
[15]SANDWEISS A J,COTTIER K E,MCINTOSH M I,et al.17-β-Estradiol induces spreading depression and pain behavior in alert female rats[J].Oncotarget,2017,8(69):114109-114122.
[16]LI J,CHEN J,QIN Q,et al.Chronic pain and its association with obesity among older adults in China[J].Arch Gerontol Geriatr,2018,76:12-18.
[17]RUSU A C,PINCUS T.Chronic pain patients’perceptions of their future:A verbal fluency task[J].Pain,2017,158(1):171-178.
[18]黄琳,刘琴,杨丽萍,等.社区疼痛老年人慢性疼痛体验及其影响因素研究[J].中国卫生工程学,2018,17(1):69-71.
[19]陈培莲.关注老年慢性疼痛患者[J].老年医学与保健,2018,24(5):564-566.
[20]孟文君,魏昕,柴小青,等.急性、慢性疼痛病人的痛阈及焦虑状态的比较[J].中国疼痛医学杂志,2018,24(1):40-44.
[21]贺永进,吕丹,王准,等.慢性疼痛治疗现状[J].中国现代神经疾病杂志,2018,18(10):703-704.
[22]TRAN P,STURGEON J A,NILAKANTAN A,et al.Pain catastrophizing mediates the relationship between trait happiness and depressive symptoms in individuals with current pain[J].J Appl Biobehav Res,2017,22(4):e12609.
[23]江倩倩,贾泽娟,张昭,等.心理干预改善慢性疼痛的研究进展[J].齐鲁护理杂志,2018,24(15):100-102.
[24]杨向东.心理干预对慢性疼痛患者社会心理状态的影响[J].临床研究,2018,26(7):184-185.
[25]宋春燕,吴红艳,戴红梅,等.慢性疼痛门诊患者心理体验的现象学研究[J].护理学杂志,2017,32(23):81-84.
[26]刘倩,李小霞,黄旭,等.慢性疼痛对社区老年人身心健康的影响[J].北京医学,2017,39(11):1186-1187.
[27]蔡宏澜,段宝霖,王雅,等.慢性疼痛病人伴发焦虑、抑郁和躯体化症状的现况分析[J].中国疼痛医学杂志,2017,23(10):788-790.
[28]DOROUDI T,KOLIVAND P,DIVANBEIGI A,et al.Comparing diagnostic accuracy of direct questioning versus schematic evaluation of chronic pain localization[J].Acta Clin Croat,2017,56(4):689-697.
[29]赵昍朋,张媛,张柏宁.慢性疼痛与抑郁的研究进展[J].内蒙古医科大学学报,2017,39(4):386-389.
[30]施华,马世龙,潘兰霞.慢性疼痛对老年人日常生活影响及应对方式调查[J].中医临床研究,2016,8(32):114-116.
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