上海市石门二路社区老年人抑郁症状调查分析
摘要
目的调查社区老年人口学特征及老年人抑郁症状发生情况,分析其相关因素,并提出相应的改善措施。
方法采用问卷调查法,包括自编一般情况表、老年抑郁量表(GeriatricDepression Scale,GDS)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)、简明健康状况调查表(Short Form of 36,SF-36),于2005年9月至11月间,以整群抽样方法,选取静安区石门二路社区4个居委,以其中60岁至89岁、能够正确理解问卷内容的老年志愿者作为调查对象。
完成调查后,经复核、补漏,及时纠正调查表差错,确认资料合格。所得资料统一编号,录入SPSS13.0统计软件,采用单因素X~2检验和多因素logistic回归,分析老年人抑郁、焦虑症状的相关因素;采用单因素方差分析方法(One-way ANOVA),分析抑郁、焦虑症状与SF-36量表各项得分的关系。
结果
1.共有1731名老年人接受并完成调查,297名老年人被检出抑郁症状,检出率达17.2%;50名被检出焦虑症状,检出率为2.9%;有46名抑郁、焦虑症状合并发生,约占总数的2.7%。
2.社区老年人口学特征:1731名居民中,(1)性别:男性759名,女性972名,(2)年龄:范围60岁至89岁,平均年龄73.7±8.1岁;(3)婚姻及居住形式:在婚状态老年人1214名(70.1%),不在婚状态(包括未婚、离婚与丧偶)517名(29.9%);独居老人171名(9.9%),非独居老人1560名(90.1%);(4)文化程度与退休前职业:高中及以上的文化886名(50.3%),退休前从事脑力劳动为主者1016名,比例高达58.9%;(5)家庭开支方面:987名(57.0%)老人表示足够开支,667名(38.5%)勉强够,只有77名老人(4.4%)表示不够开支;(6)将近50%的老年人不参与社区或邻里活动,也有相当多的老人反映无业余爱好或较少,而较少数的人认为缺乏家庭支持;(7)社区老年慢性疾病患病普遍,只有195名老年人(11.3%)自诉无慢性疾病(包括未患或未检出或未检查过),其余1536名老年人(88.7%)患不同程度的慢性疾病,以高血压病、心脏病、糖尿病等常见,患有高血压病者864名,占总人数的49.9%,心脏病459名(26.5%),糖尿病242名(14.0%);(8)医疗费用支付形式方面,绝大多数(91.5%)享有上海市城镇医疗保险。
3.抑郁症状相关因素的Logistic回归分析表明,有10个变量进入回归方程,这10个变量分别为独居、生活自理能力、家庭人均月收入、医疗费用支付形式、家庭开支、业余爱好、参与社区活动、家庭支持、疾病数目及自评疾病的严重程度。未进入回归方程的5个变量为:性别、年龄、婚姻状况、教育程度及退休前职业,这5个变量与抑郁症状的发生无明显相关性。
4.焦虑症状相关因素的Logistic回归分析表明,有3个变量进入回归方程,分别为独居、家庭开支、自评疾病严重程度,其余因素均未进入方程。
5.发生抑郁症状的老年人生命质量SF-36量表的8个维度的得分均下降,与未发生抑郁症状者相比,差别都有统计学意义。
结论
1.与抑郁症状发生有相关的因素,包括居住、生活自理能力、经济状况、业余爱好与活动、慢性躯体疾病等。
2.抑郁症状的发生率要高于焦虑症状,发生焦虑者几乎都伴随抑郁。焦虑症状发生的3个相关因素是独居、家庭开支、自评疾病严重程度。
3.有抑郁症状的老年人的生命质量整体下降。
Objective:To investigate the depression incidence of the elderly people in community and try to discover the associated factors,as well as to provide related coping strategies to improve the life qualities of the aged.
Method:Perform the inquiry with questionnaire including four sections as follows,the General Background Inventory,the Geriatric Depression Scale(GDS),Self-Rating Anxiety Scale(SAS) and Short form of 36(SF-36).
During September to November in 2005,the elderly aged 60 to 89, from 4 communities in shi-men No.2 road through cluster sampling, were enrolled in the study,who could understand and answer all the questions,voluntarily.
The inquiry was performed by doctors in the community,who were strictly trained before taking this job.Checks,corrections and amendments were also needed after the test.
All data were carried in SPSS13.0 with statistic method such as Chi-square test,Logistic Regression and One-way ANOVA.
Result:1731 elderly people finished the questionnaire.Among them,297(17.2%) had suffered depression,50(2.9%) people had anxiety and 46(2.7%) objectives had suffered from anxiety-depression. Particulars of the aged in communities:male 759(43.8%),female 972(56.2%);average age was 73.7±8.1;Marital status and living condition:70.1%married;29.9%unmarried,widowed or divorced; 9.9%single-lived,90.1%not single-lived;50.3%senior school or over graduated;58.9%mental labored before retirement;57.0%family expenses balanced,38.5%just balanced,but 4.4%unbalanced;Nearly 50%showed no interest in joining the community activities;Some aged people lacked of hobbies;Only a small number of aged people lacked of family support;Most aged people suffered from chronic disease,and only 11.3%was exceptional;Hypertension(49.9%),cardiac disease (26.5%)and diabetes(14.0%);91.5%of the elderly enjoyed Medicare provided by Shanghai government.
Ten factors entered the depression regression equation as follows: the style of residence,ability of self-management,average income, Medicare,family expense,hobbies,community activities,family support,number of disease,self-estimation for diseases severity;while five factors were not related:sex,age,marital status,educational background,profession.
Three factors entered the anxiety regression equation as follows: The style of residence,family finance,self-estimation of chronic diseases.
The scores in all 8 sections of SF-36 decreased among the aged suffered from depression,which had statistical diference.
Conclusion:
1.Four aspects associated with the elderly depression were:living style and ability of self-management,family income,social character, chronic diseases.
2.The incidence of depression was higher than that of anxiety.In most conditions,anxiety accompanied with depression.Three factors were related with anxiety:living alone,family expenses unbalanced and self-estimation for diseases severity.
3.The life quality of the eldly with depression significantly decreased.
方法采用问卷调查法,包括自编一般情况表、老年抑郁量表(GeriatricDepression Scale,GDS)、焦虑自评量表(Self-Rating Anxiety Scale,SAS)、简明健康状况调查表(Short Form of 36,SF-36),于2005年9月至11月间,以整群抽样方法,选取静安区石门二路社区4个居委,以其中60岁至89岁、能够正确理解问卷内容的老年志愿者作为调查对象。
完成调查后,经复核、补漏,及时纠正调查表差错,确认资料合格。所得资料统一编号,录入SPSS13.0统计软件,采用单因素X~2检验和多因素logistic回归,分析老年人抑郁、焦虑症状的相关因素;采用单因素方差分析方法(One-way ANOVA),分析抑郁、焦虑症状与SF-36量表各项得分的关系。
结果
1.共有1731名老年人接受并完成调查,297名老年人被检出抑郁症状,检出率达17.2%;50名被检出焦虑症状,检出率为2.9%;有46名抑郁、焦虑症状合并发生,约占总数的2.7%。
2.社区老年人口学特征:1731名居民中,(1)性别:男性759名,女性972名,(2)年龄:范围60岁至89岁,平均年龄73.7±8.1岁;(3)婚姻及居住形式:在婚状态老年人1214名(70.1%),不在婚状态(包括未婚、离婚与丧偶)517名(29.9%);独居老人171名(9.9%),非独居老人1560名(90.1%);(4)文化程度与退休前职业:高中及以上的文化886名(50.3%),退休前从事脑力劳动为主者1016名,比例高达58.9%;(5)家庭开支方面:987名(57.0%)老人表示足够开支,667名(38.5%)勉强够,只有77名老人(4.4%)表示不够开支;(6)将近50%的老年人不参与社区或邻里活动,也有相当多的老人反映无业余爱好或较少,而较少数的人认为缺乏家庭支持;(7)社区老年慢性疾病患病普遍,只有195名老年人(11.3%)自诉无慢性疾病(包括未患或未检出或未检查过),其余1536名老年人(88.7%)患不同程度的慢性疾病,以高血压病、心脏病、糖尿病等常见,患有高血压病者864名,占总人数的49.9%,心脏病459名(26.5%),糖尿病242名(14.0%);(8)医疗费用支付形式方面,绝大多数(91.5%)享有上海市城镇医疗保险。
3.抑郁症状相关因素的Logistic回归分析表明,有10个变量进入回归方程,这10个变量分别为独居、生活自理能力、家庭人均月收入、医疗费用支付形式、家庭开支、业余爱好、参与社区活动、家庭支持、疾病数目及自评疾病的严重程度。未进入回归方程的5个变量为:性别、年龄、婚姻状况、教育程度及退休前职业,这5个变量与抑郁症状的发生无明显相关性。
4.焦虑症状相关因素的Logistic回归分析表明,有3个变量进入回归方程,分别为独居、家庭开支、自评疾病严重程度,其余因素均未进入方程。
5.发生抑郁症状的老年人生命质量SF-36量表的8个维度的得分均下降,与未发生抑郁症状者相比,差别都有统计学意义。
结论
1.与抑郁症状发生有相关的因素,包括居住、生活自理能力、经济状况、业余爱好与活动、慢性躯体疾病等。
2.抑郁症状的发生率要高于焦虑症状,发生焦虑者几乎都伴随抑郁。焦虑症状发生的3个相关因素是独居、家庭开支、自评疾病严重程度。
3.有抑郁症状的老年人的生命质量整体下降。
Objective:To investigate the depression incidence of the elderly people in community and try to discover the associated factors,as well as to provide related coping strategies to improve the life qualities of the aged.
Method:Perform the inquiry with questionnaire including four sections as follows,the General Background Inventory,the Geriatric Depression Scale(GDS),Self-Rating Anxiety Scale(SAS) and Short form of 36(SF-36).
During September to November in 2005,the elderly aged 60 to 89, from 4 communities in shi-men No.2 road through cluster sampling, were enrolled in the study,who could understand and answer all the questions,voluntarily.
The inquiry was performed by doctors in the community,who were strictly trained before taking this job.Checks,corrections and amendments were also needed after the test.
All data were carried in SPSS13.0 with statistic method such as Chi-square test,Logistic Regression and One-way ANOVA.
Result:1731 elderly people finished the questionnaire.Among them,297(17.2%) had suffered depression,50(2.9%) people had anxiety and 46(2.7%) objectives had suffered from anxiety-depression. Particulars of the aged in communities:male 759(43.8%),female 972(56.2%);average age was 73.7±8.1;Marital status and living condition:70.1%married;29.9%unmarried,widowed or divorced; 9.9%single-lived,90.1%not single-lived;50.3%senior school or over graduated;58.9%mental labored before retirement;57.0%family expenses balanced,38.5%just balanced,but 4.4%unbalanced;Nearly 50%showed no interest in joining the community activities;Some aged people lacked of hobbies;Only a small number of aged people lacked of family support;Most aged people suffered from chronic disease,and only 11.3%was exceptional;Hypertension(49.9%),cardiac disease (26.5%)and diabetes(14.0%);91.5%of the elderly enjoyed Medicare provided by Shanghai government.
Ten factors entered the depression regression equation as follows: the style of residence,ability of self-management,average income, Medicare,family expense,hobbies,community activities,family support,number of disease,self-estimation for diseases severity;while five factors were not related:sex,age,marital status,educational background,profession.
Three factors entered the anxiety regression equation as follows: The style of residence,family finance,self-estimation of chronic diseases.
The scores in all 8 sections of SF-36 decreased among the aged suffered from depression,which had statistical diference.
Conclusion:
1.Four aspects associated with the elderly depression were:living style and ability of self-management,family income,social character, chronic diseases.
2.The incidence of depression was higher than that of anxiety.In most conditions,anxiety accompanied with depression.Three factors were related with anxiety:living alone,family expenses unbalanced and self-estimation for diseases severity.
3.The life quality of the eldly with depression significantly decreased.
引文
[1]郎森阳.老年人群中常见的抑郁焦虑症状的诊治[J].解放军保健医学杂志,2006,8(1):13-16.
[2]吕探云,杨英华.上海市社区老人长期护理需要[J].中华护理杂志,2001,36(8):565-568.
[3]季建林.抑郁障碍:临床治疗所面临的挑战——欧洲继续医学教育研讨会纪要[J].上海精神医学,2007,19(3):189.
[4]Butcher HK,McGonigal-Kenney M.Depression and dispiritedness in later life:a 'gray drizzle of horror' isn't inevitable[J].The American Journal of Nursing.2005,105(12):52-61.
[5]Gebretsadik M,Jayaprabhu S,Grossberg GT.Mood disorders in the elderly[J].The Medical Clinic of North America,2006,90(5):789-805.
[6]吕探云,马敏芝,曹育玲等.社区老年人抑郁症状及其影响因素的研[J].护理学杂志,2001,16(7):387-389.
[7]赵濛,张军.老年抑郁的发生及其影响因素分析[J].中国初级卫生保健,2001,15(10):54-55.
[8]孟琛,项曼君.北京老年人的抑郁状况调查及CES-D的结构分析[J].中国心理卫生杂志,1997,11(1):55-58.
[9]饶顺曾,陈碧霞,周治荣等.社区老年人焦虑、抑郁状况的调查[J].上海精神医学,2002,14(2):77-79.
[10]韩冬梅,付石,全晓燕.包头市老年人抑郁症状调查及影响因素分析[J].包头医学院学报,2002,17(4):264-265.
[11]刘艺敏,徐思红,梁丹丹等.上海市部分地区中老年人抑郁状况调查[J].同济大学学报(医学版)2006,27(5):82-85.
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[1]郎森阳.老年人群中常见的抑郁焦虑症状的诊治[J].解放军保健医学杂志,2006,8(1)期:13-16.
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[10]季建林.医学心理学[M].上海:复旦大学出版社.2001:223-224.
[11]饶顺曾,陈碧霞,周治荣等.社区老年人焦虑、抑郁状况的调查[J].上海精神医学,2002,14(2):77-79.
[12]吴文源,俞勤奋,张明圆.老年人抑郁症状的影响因素[J].中国心理卫生杂志,1992,6(6):256-257.
[13]孟琛,项曼君.北京老年人的抑郁状况调查及CES-D的结构分析[J].中国心理卫生杂志,1997,11(1):55-57.
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[2]吕探云,杨英华.上海市社区老人长期护理需要[J].中华护理杂志,2001,36(8):565-568.
[3]季建林.抑郁障碍:临床治疗所面临的挑战——欧洲继续医学教育研讨会纪要[J].上海精神医学,2007,19(3):189.
[4]Butcher HK,McGonigal-Kenney M.Depression and dispiritedness in later life:a 'gray drizzle of horror' isn't inevitable[J].The American Journal of Nursing.2005,105(12):52-61.
[5]Gebretsadik M,Jayaprabhu S,Grossberg GT.Mood disorders in the elderly[J].The Medical Clinic of North America,2006,90(5):789-805.
[6]吕探云,马敏芝,曹育玲等.社区老年人抑郁症状及其影响因素的研[J].护理学杂志,2001,16(7):387-389.
[7]赵濛,张军.老年抑郁的发生及其影响因素分析[J].中国初级卫生保健,2001,15(10):54-55.
[8]孟琛,项曼君.北京老年人的抑郁状况调查及CES-D的结构分析[J].中国心理卫生杂志,1997,11(1):55-58.
[9]饶顺曾,陈碧霞,周治荣等.社区老年人焦虑、抑郁状况的调查[J].上海精神医学,2002,14(2):77-79.
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