性早熟女性患儿及其母亲的心理功能评估
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摘要
目的探讨采取不同量表评估法,对性早熟患儿及其母亲的心理功能评估的价值。方法选择2016年3月至2018年1月,在秦皇岛市妇幼保健院儿科就诊的70例女性受试儿为研究对象,按照其是否合并性早熟及其性早熟类型,将其分为中枢性性早熟(CPP)组(n=24)、肾上腺功能早现(PA)组(n=22)和青春期早期发育正常(ENP)组(n=24)3组。所有受试儿及其母亲在初诊后2周内,采用不同量表进行心理功能评估。对于年龄≥6.0岁的受试儿,采用自我报告的方式进行心理功能评估,使用的量表包括《儿童抑郁量表》(CDI)和《哈特儿童感知能力量表》(Harter量表);对于年龄为1.5～5.0岁的受试儿,采用家长报告的方式进行心理功能评估,采用的量表为《儿童行为量表》(CBCL)。对纳入研究受试儿母亲的心理功能评估,采用"李克特量表"5点测量法(Likert量表),《抑郁、焦虑和压力量表》(DASS)和《积极和消极情绪时间表》(PANAS)进行心理功能评估。本研究遵循的程序通过秦皇岛市妇幼保健院医学伦理委员会的审查与批准(批准文号:医科伦审2016第61号),所有受试儿监护人均签署临床研究知情同意书。结果①3组受试儿母亲分娩时年龄及受试儿晚出方式构成比比较,差异均无统计学意义(P>0.05)。但是,3组受试儿年龄比较,差异有统计学意义(P<0.05)。②3组受试儿CDI总分、Harter量表的4个子项目和CBCL的2个子项目得分分别比较,差异均无统计学意义(P>0.05)。③对CPP组、PA组和ENP组3组受试儿母亲的心理功能评估结果显示,受试儿母亲的DASS中,抑郁子项目得分分别为(3.9±0.5)分、(4.7±0.8)分和(1.2±0.3)分,紧张子项目得分分别为(8.7±2.6)分、(10.9±3.0)分和(4.9±0.5)分,3组受试儿母亲上述得分分别比较,差异均有统计学意义(F=6.184、P=0.035,F=7.228、P=0.014)。对这2个项目的得分进一步进行两两比较结果显示,PA组受试儿母亲的得分,均高于ENP组,并且差异均有统计学意义(t=6.322、P=0.021,t=7.356、P=0.013)。此外, 3组受试儿母亲的DASS压力子项目得分、Likert量表5个项目得分和PANAS 2个子项目得分分别总体比较,差异均无统计学意义(P>0.05)。结论 PA女性患儿母亲抑郁和紧张程度较高。在诊断时,心理压力不是对女性性早熟患儿进行治疗的明确指征。
Objective To explore the psychological function of children with precocious puberty and their mothers. Methods From March 2016 to January 2018, 70 grils who visited the Department of Pediatrics of Maternal & Child Care Center of Qinghuangdao were selected into this study. They were divided into 3 groups according to whether they were complicated with precocious puberty, central precocious puberty(CPP) group(n=24), premature adrenarche(PA) group(n=22) and early normal puberty(ENP) group(n=24). All the 70 girls and their mothers were assessed with scales within 2 weeks after their first visits. Children older than 6.0 years were assessed by self-report of Children′s Depression Inventory(CDI) and Harter Pictorial Scale of Perceived Competence(Harter scale), and children aged 1.5-5.0 years old were assessed by parent report of Child Behavior Checklist(CBCL). Mothers′ psychological functions were assessed by using 5-Point Likert Scale, Depression, Anxiety and Stress Scale(DASS), and Positive and Negative Affect Schedule(PANAS). The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of Maternal & Child Care Center of Qinghuangdao [Approval No. 2016(61)]. All the guardians of the girls signed clinical research informed consents. Results ①There were no significant differences among 3 groups in age at delivery of mothers and modes of delivery(P>0.05). However, there was a statistically significant difference among 3 groups in the aspect of age(P<0.05). ②There were no significant differences among 3 groups in the aspects of total scores of CDI, 4 sub-items of Harter scale and 2 sub-items of CBCL(P>0.05). ③The psychological function evaluation results of mothers of 3 groups were as follows. The depression sub-item scores in DASS of CPP group, PA group and ENP group were(3.9±0.5) scores,(4.7±0.8) scores and(1.2±0.3) scores, respectively, and the tension sub-item scores were(8.7±2.6) scores,(10.9±3.0) scores and(4.9±0.5) scores, respectively. The differences among 3 groups were statistically significant(F=6.184, P=0.035; F=7.228, P=0.014). Further comparison showed that the scores of PA group were higher than those of ENP group, and the differences were statistically significant(t=6.322, P=0.021; t=7.356, P=0.013). While there were no significant differences among 3 groups in the aspects of the scores of stress sub-items in DASS, scores of 5 items of Likert scale and 2 items of PANAS of mothers(P>0.05). Conclusions The mother of female PA children has higher depression and tension. Psychological pressure is not an indication for the treatment of precocious puberty.
Objective To explore the psychological function of children with precocious puberty and their mothers. Methods From March 2016 to January 2018, 70 grils who visited the Department of Pediatrics of Maternal & Child Care Center of Qinghuangdao were selected into this study. They were divided into 3 groups according to whether they were complicated with precocious puberty, central precocious puberty(CPP) group(n=24), premature adrenarche(PA) group(n=22) and early normal puberty(ENP) group(n=24). All the 70 girls and their mothers were assessed with scales within 2 weeks after their first visits. Children older than 6.0 years were assessed by self-report of Children′s Depression Inventory(CDI) and Harter Pictorial Scale of Perceived Competence(Harter scale), and children aged 1.5-5.0 years old were assessed by parent report of Child Behavior Checklist(CBCL). Mothers′ psychological functions were assessed by using 5-Point Likert Scale, Depression, Anxiety and Stress Scale(DASS), and Positive and Negative Affect Schedule(PANAS). The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of Maternal & Child Care Center of Qinghuangdao [Approval No. 2016(61)]. All the guardians of the girls signed clinical research informed consents. Results ①There were no significant differences among 3 groups in age at delivery of mothers and modes of delivery(P>0.05). However, there was a statistically significant difference among 3 groups in the aspect of age(P<0.05). ②There were no significant differences among 3 groups in the aspects of total scores of CDI, 4 sub-items of Harter scale and 2 sub-items of CBCL(P>0.05). ③The psychological function evaluation results of mothers of 3 groups were as follows. The depression sub-item scores in DASS of CPP group, PA group and ENP group were(3.9±0.5) scores,(4.7±0.8) scores and(1.2±0.3) scores, respectively, and the tension sub-item scores were(8.7±2.6) scores,(10.9±3.0) scores and(4.9±0.5) scores, respectively. The differences among 3 groups were statistically significant(F=6.184, P=0.035; F=7.228, P=0.014). Further comparison showed that the scores of PA group were higher than those of ENP group, and the differences were statistically significant(t=6.322, P=0.021; t=7.356, P=0.013). While there were no significant differences among 3 groups in the aspects of the scores of stress sub-items in DASS, scores of 5 items of Likert scale and 2 items of PANAS of mothers(P>0.05). Conclusions The mother of female PA children has higher depression and tension. Psychological pressure is not an indication for the treatment of precocious puberty.
引文
[1] Tirumuru SS, Arya P, Latthe P, et al. Understanding precocious puberty in girls [J]. Obstet Gynaecol, 2012, 14(2): 121-129.
[2] 刘兆祥,伍学焱. 特发性中枢性性早熟基因研究进展[J]. 中华医学杂志,2015, 95(2): 156-158.
[3] Bridges NA, Christopher JA, Hindmarsh PC, et al. Sexual precocity: sex incidence and aetiology [J]. Arch Dis Child, 1994, 70(2): 116-118.
[4] Chaplin TM, Niehaus C, Gon?alves SF. Stress reactivity and the developmental psychopathology of adolescent substance use [J]. Neurobiol Stress, 2018, 9(1): 133-139.
[5] Platt JM, Colich NL, McLaughlin KA, et al. Transdiagnostic psychiatric disorder risk associated with early age of menarche: a latent modeling approach [J]. Compr Psychiatry, 2017, 79: 70-79.
[6] Trepanier L, Juster RP, Marin MF, et al. Early menarche predicts increased depressive symptoms and cortisol levels in Quebec girls ages 11 to 13 [J]. Dev Psychopathol, 2013, 25(4 Pt 1): 1017-1027.
[7] Ehrhardt AA, Meyer-Bahlburg HF. Psychosocial aspects of precocious puberty [J]. Horm Res, 1994, 41(Suppl 2): 30-35.
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[9] Mrug S, Elliott MN, Davies S, et al. Early puberty, negative peer influence, and problem behaviors in adolescent girls [J]. Pediatrics, 2014, 133(1): 7-14.
[10] Swaiss HH, Khawaja NM, Farahid OH, et al.Effect of gonadotropin-releasing hormone analogue on final adult height among Jordanian children with precocious puberty [J]. Saudi Med J, 2017, 38(11): 1101-1107.
[11] Sayarifard F, Imcheh FB, Badri S, et al. Growth hormone utilization review in a pediatric primary care setting [J]. J Res Pharm Pract, 2017, 6(1): 40-43.
[12] Eriksson C, Kimber B, Skoog T. Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol [J]. BMC Public Health, 2018, 18(1): 1250.
[13] 中华医学会儿科学分会内分泌遗传代谢学组.中枢性(真性)性早熟诊治指南[J].中华儿科杂志, 2007, 45(6): 426-427.
[14] 郑荣秀,刘戈力.女童性早熟的临床诊断程序[J].实用儿科临床杂志,2011,26(8):557-560.
[15] 洪忻,李解权,梁亚琼,等.儿童抑郁量表中文版在中学生中的信效度分析[J]. 中国学校卫生,2012,33(10):1182-1185.
[16] 丁雪辰,刘俊升,李丹,等. Harter儿童自我知觉量表的信效度检验[J].中国临床心理学杂志,2014,22(2):251-255.
[17] Xhrouet-Heinrichs D, Lagrou K, Heinrichs C, et al. Longitudinal study of behavioral and affective patterns in girls with central precocious puberty during long-acting triptorelin therapy [J]. Acta Paediatr, 1997, 86(8): 808-815.
[18] 吴永泽,王文绢.不同应答等级对likert式量表特性的影响[J].中国慢性病预防与控制,2010,18(2):215-217.
[19] 谢家树,刘姗,Yang CY,et al. 社会与情绪健康量表(中学版)中文版修订[J].中国临床心理学杂志,2017,25(6):1012-1016.
[20] Kim EY, Lee MI. Psychosocial aspects in girls with idiopathic precocious puberty [J]. Pshchiatr Investig, 2012, 9(1): 25-28.
[21] 潘婷婷, 丁雪辰, 桑标, 等. 正负性情感量表儿童版(PANAS-C)的信效度初探[J].中国临床心理学杂志,2015,23(3):397-400.
[22] Kaplowitz PB, Backeljauw PF, Allen DB. Toward more targeted and cost-effective gonadotropin-releasing hormone analog treatment in girls with central precocious puberty [J]. Horm Res Paediatr, 2018, 90(1): 1-7.
[23] Schoelwer MJ, Donahue KL, Didrick P, et al. One-year follow-up of girls with precocious puberty and their mothers: do psychological assessments change over time or with treatment? [J]. Horm Res Paediatr, 2017, 88(5): 347-353.
[24] Sontag-Padilla LM, Dorn LD, Tissot A, et al. Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche[J]. Dev Psychopathol, 2012, 24(1): 211-223.
[2] 刘兆祥,伍学焱. 特发性中枢性性早熟基因研究进展[J]. 中华医学杂志,2015, 95(2): 156-158.
[3] Bridges NA, Christopher JA, Hindmarsh PC, et al. Sexual precocity: sex incidence and aetiology [J]. Arch Dis Child, 1994, 70(2): 116-118.
[4] Chaplin TM, Niehaus C, Gon?alves SF. Stress reactivity and the developmental psychopathology of adolescent substance use [J]. Neurobiol Stress, 2018, 9(1): 133-139.
[5] Platt JM, Colich NL, McLaughlin KA, et al. Transdiagnostic psychiatric disorder risk associated with early age of menarche: a latent modeling approach [J]. Compr Psychiatry, 2017, 79: 70-79.
[6] Trepanier L, Juster RP, Marin MF, et al. Early menarche predicts increased depressive symptoms and cortisol levels in Quebec girls ages 11 to 13 [J]. Dev Psychopathol, 2013, 25(4 Pt 1): 1017-1027.
[7] Ehrhardt AA, Meyer-Bahlburg HF. Psychosocial aspects of precocious puberty [J]. Horm Res, 1994, 41(Suppl 2): 30-35.
[8] Galvao TF, Silva MT, Zimmermann IR, et al. Pubertal timing in girls and depression: a systematic review [J]. J Affect Disord, 2014, 155: 13-19.
[9] Mrug S, Elliott MN, Davies S, et al. Early puberty, negative peer influence, and problem behaviors in adolescent girls [J]. Pediatrics, 2014, 133(1): 7-14.
[10] Swaiss HH, Khawaja NM, Farahid OH, et al.Effect of gonadotropin-releasing hormone analogue on final adult height among Jordanian children with precocious puberty [J]. Saudi Med J, 2017, 38(11): 1101-1107.
[11] Sayarifard F, Imcheh FB, Badri S, et al. Growth hormone utilization review in a pediatric primary care setting [J]. J Res Pharm Pract, 2017, 6(1): 40-43.
[12] Eriksson C, Kimber B, Skoog T. Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol [J]. BMC Public Health, 2018, 18(1): 1250.
[13] 中华医学会儿科学分会内分泌遗传代谢学组.中枢性(真性)性早熟诊治指南[J].中华儿科杂志, 2007, 45(6): 426-427.
[14] 郑荣秀,刘戈力.女童性早熟的临床诊断程序[J].实用儿科临床杂志,2011,26(8):557-560.
[15] 洪忻,李解权,梁亚琼,等.儿童抑郁量表中文版在中学生中的信效度分析[J]. 中国学校卫生,2012,33(10):1182-1185.
[16] 丁雪辰,刘俊升,李丹,等. Harter儿童自我知觉量表的信效度检验[J].中国临床心理学杂志,2014,22(2):251-255.
[17] Xhrouet-Heinrichs D, Lagrou K, Heinrichs C, et al. Longitudinal study of behavioral and affective patterns in girls with central precocious puberty during long-acting triptorelin therapy [J]. Acta Paediatr, 1997, 86(8): 808-815.
[18] 吴永泽,王文绢.不同应答等级对likert式量表特性的影响[J].中国慢性病预防与控制,2010,18(2):215-217.
[19] 谢家树,刘姗,Yang CY,et al. 社会与情绪健康量表(中学版)中文版修订[J].中国临床心理学杂志,2017,25(6):1012-1016.
[20] Kim EY, Lee MI. Psychosocial aspects in girls with idiopathic precocious puberty [J]. Pshchiatr Investig, 2012, 9(1): 25-28.
[21] 潘婷婷, 丁雪辰, 桑标, 等. 正负性情感量表儿童版(PANAS-C)的信效度初探[J].中国临床心理学杂志,2015,23(3):397-400.
[22] Kaplowitz PB, Backeljauw PF, Allen DB. Toward more targeted and cost-effective gonadotropin-releasing hormone analog treatment in girls with central precocious puberty [J]. Horm Res Paediatr, 2018, 90(1): 1-7.
[23] Schoelwer MJ, Donahue KL, Didrick P, et al. One-year follow-up of girls with precocious puberty and their mothers: do psychological assessments change over time or with treatment? [J]. Horm Res Paediatr, 2017, 88(5): 347-353.
[24] Sontag-Padilla LM, Dorn LD, Tissot A, et al. Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche[J]. Dev Psychopathol, 2012, 24(1): 211-223.