甲状腺功能减退症患者心理健康状况及影响因素分析
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摘要
目的:研究甲状腺功能减退症患者的心理健康状况及其影响因素,为预防、改善甲减患者心理健康状况提供参考依据。方法:选取2014年1月-2016年1月来我院治疗的226例甲减患者作为甲减组,另从杨浦区多个社区随机抽取同期254例健康者作为健康组,采用SCL-90症状自评量表、社会支持评定量表(SSRS)及一般情况调查问卷对两组研究对象进行调查,采用Logistic回归分析甲减患者的影响因素。结果:两组性别、年龄及职业之间的差异无统计学意义(P>0.05),而文化程度、经济收入的差异具有统计学意义(P<0.05);甲减组患者强迫症状、抑郁、焦虑、精神病性评分及总分均高于健康组(P<0.05);甲减组患者中焦虑、抑郁、人际关系敏感所占比重较高,分别为30.97%,26.11%,26.11%;与健康组相比,甲减组患者SSRS评分中主观支持、客观支持、支持利用度评分及总分均明显降低(P<0.05);多因素Logistic回归分析显示社会支持、文化程度为小学、经济收入<30000元/年是甲减患者心理健康的影响因素(P<0.05)。结论:甲减患者心理状况较差,存在较严重的焦虑和抑郁情况,在治疗同时应注意健康教育和心理关怀,尤其是对收入低、文化程度低或社会支持程度低的患者,应给予及时的心理治疗,可提高患者的生活质量。
Objective: To study the mental health status and the influencing factors of patients with hypothyroidism, and to provide references for prevention and improvement of hypothyroidism patients. Methods: A total of 226 patients with hypothyroidism, who were treated in Affiliated Changhai Hospital of Second Military Medical University from January 2014 to January 2016, were chosen as hypothyroidism group, and 254 healthy subjects selected from several communities in Yangpu district as healthy group in the same period.The two groups were investigated by the SCL-90 symptoms self-evaluation scale, social support rating scale(SSRS) and general situation questionnaire. The influencing factors of patients with hypothyroidism were analysed by Logistic regression analysis. Results: There were no statistical differences in the gender, age and occupation between the two groups(P>0.05), but there were statistical differences in the cultural degree and economic income(P<0.05). The scores and total scores of the obsessive compulsive symptoms, depression, anxiety and psychoticism in the hypothyroidism group were higher than those in the healthy group(P<0.05). The anxiety, depression, and interpersonal sensitivity proportion in the hypothyroidism group were higher, which were 30.97%, 26.11%, 26.11% respectively. Compared with the healthy group, the scores and total scores of subjective support, objective support,and support utilization in the hypothyroidism group were significantly decreased(P<0.05). The multi-factor Logistic regression analysis showed that the influencing factors of mental health in the Hypothyroidism patients were economic income<30000 yuan/year, culture degree and the degree of social support. Conclusion: Hypothyroidism patients have bad mental health, who are suffering from serious anxiety and depression. They should be paid more attention to health education and psychological care during medical treatment, especially for the patients with low income, low level of education or low degree of social support. Reinforcing mental health services can improve the patients' quality of life.
Objective: To study the mental health status and the influencing factors of patients with hypothyroidism, and to provide references for prevention and improvement of hypothyroidism patients. Methods: A total of 226 patients with hypothyroidism, who were treated in Affiliated Changhai Hospital of Second Military Medical University from January 2014 to January 2016, were chosen as hypothyroidism group, and 254 healthy subjects selected from several communities in Yangpu district as healthy group in the same period.The two groups were investigated by the SCL-90 symptoms self-evaluation scale, social support rating scale(SSRS) and general situation questionnaire. The influencing factors of patients with hypothyroidism were analysed by Logistic regression analysis. Results: There were no statistical differences in the gender, age and occupation between the two groups(P>0.05), but there were statistical differences in the cultural degree and economic income(P<0.05). The scores and total scores of the obsessive compulsive symptoms, depression, anxiety and psychoticism in the hypothyroidism group were higher than those in the healthy group(P<0.05). The anxiety, depression, and interpersonal sensitivity proportion in the hypothyroidism group were higher, which were 30.97%, 26.11%, 26.11% respectively. Compared with the healthy group, the scores and total scores of subjective support, objective support,and support utilization in the hypothyroidism group were significantly decreased(P<0.05). The multi-factor Logistic regression analysis showed that the influencing factors of mental health in the Hypothyroidism patients were economic income<30000 yuan/year, culture degree and the degree of social support. Conclusion: Hypothyroidism patients have bad mental health, who are suffering from serious anxiety and depression. They should be paid more attention to health education and psychological care during medical treatment, especially for the patients with low income, low level of education or low degree of social support. Reinforcing mental health services can improve the patients' quality of life.
引文
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[24]Park YJ,Lee EJ,Lee YJ,et al.Subclinical hypothyroidism(SCH)is not associated with metabolic derangement,cognitive impairment,depression or poor quality of life(Qo L)in elderly subjects[J].Arch Gerontol Geriatr,2010,50(3):e68-e73
[25]Wouters HJ,Van Loon HC,Van der Klauw MM,et al.No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters,Health-Related Quality of Life,and Cognitive Functioning in a Large Population-Based Cohort Study[J].Thyroid,2017,27(2):147-155
[26]Pasquali D,Carotenuto M,Leporati P,et al.Maternal hypothyroidism and subsequent neuropsychological outcome of the progeny:a family portrait[J].Endocrine,2015,50(3):797-801
[27]Rakhshan M Ph D,Ghanbari A Bs,Rahimi A Ms,et al.A Comparison between the Quality of Life and Mental Health of Patients with Hypothyroidism and Normal People Referred to Motahari Clinic of Shiraz University of Medical Sciences[J].Int J Community Based Nurs Midwifery,2017,5(1):30-37
[28]Sikjaer T,Moser E,Rolighed L,et al.Concurrent Hypoparathyroidism Is Associated With Impaired Physical Function and Quality of Life in Hypothyroidism[J].J Bone Miner Res,2016,31(7):1440-1448
[29]Taieb D,Bournaud C,Eberle MC,et al.Quality of life,clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves'hyperthyroidism undergoing radioiodine therapy:a randomized controlled study[J].Eur J Endocrinol,2016,174(4):491-502
[30]Krysiak R,Szkróbka W,OkopieńB.The effect of l-thyroxine treatment on sexual function and depressive symptoms in men with autoimmune hypothyroidism[J].Pharmacol Rep,2017,69(3):432-437
[2]Meng L,Rijntjes E,Swarts HJ,et al.Prolonged hypothyroidism severely reduces ovarian follicular reserve in adult rats[J].J Ovarian Res,2017,10(1):19
[3]Skibitsky VV,Fendrikova AV,Pyhalova NE,et al.The Effectiveness of Combination Antihypertensive Therapy in Women with Hypothyroidism and the Metabolic Syndrome[J].Kardiologiia,2016,56(9):32-39
[4]Jung WJ,Park SM,Park JM,et al.Severe Hypernatremia Caused by Acute Exogenous Salt Intake Combined with Primary Hypothyroidism[J].Electrolyte Blood Press,2016,14(2):27-30
[5]Pardo Campos ML,Musso M,Keselman A,et al.Cognitive profiles of patients with early detected and treated congenital hypothyroidism[J].Arch Argent Pediatr,2017,115(1):12-17
[6]Gao F,Wang G,Xu J.Alteration of Hemostatic Parameters in Patients with Different Levels of Subclinical Hypothyroidismand the Effect of L-thyroxine Treatment[J].Ann Clin Lab Sci,2017,47(1):29-35
[7]Alenazi SA,Abdalla SH,Mohamed HT,et al.Prevalence of Congenital Hypothyroidism in Northern Border Region of Kingdom of Saudi Arabia[J].Indian Pediatr,2017,54(2):154-155
[8]Wang K,Zhang J,Li F,et al.Urinary iodine in early pregnancy is associated with subclinical hypothyroidism in Tianjin,China:an observational study[J].BMC Endocr Disord,2017,17(1):10
[9]张文娟,张健,鲍琳辉,等.医学研究生心理健康状况分析[J].现代生物医学进展,2016,16(8):1541-1545,1453Zhang Wen-juan,Zhang Jian,Bao Lin-hui,et al.The Analysis on Mental Health Status of Medical Graduate Students[J].Progress in Modern Biomedicine,2016,16(8):1541-1545,1453
[10]任浩进,王丽岳,杨俊,等.社会支持评定量表在迷走性晕厥患者使用的价值[J].心血管康复医学杂志,2015,(3):249-252Ren Hao-jin,Wang Li-yue,Yang Jun,et al.Value of social support rating scale using in patients with vasovagal syncope[J].Chinese Journal of Cardiovascular Rehabilitation Medicine,2015,(3):249-252
[11]范秀红,刘润忠,黄旭,等.清远市陶瓷企业工人社会支持与心理健康的特点及其关系[J].实用预防医学,2016,23(6):687-690Fan Xiu-hong,Liu Run-zhong,Huang Xu,et al.Characteristics of social support and mental health and their relationship in ceramic workers in Qingyuan City[J].Practical Preventive Medicine,2016,23(6):687-690
[12]Keller-Petrot I,Leger J,Sergent-Alaoui A,et al.Congenital Hypothyroidism:Role of Nuclear Medicine[J].Semin Nucl Med,2017,47(2):135-142
[13]Karethimmaiah H,Sarathi V.Nephrotic Syndrome Increases the Need for Levothyroxine Replacement in Patients with Hypothyroidism[J].J Clin Diagn Res,2016,10(12):OC10-OC12
[14]Vaidya VA,Castro ME,Pei Q,et al.Influence of thyroid hormone on5-HT(1A)and 5-HT(2A)receptor-mediated regulation of hippocampal BDNF m RNA expression[J].Neuropharmacology,2001,40(1):48-56
[15]Martinez-Galan JR,Escobar del Rey F,Morreale de Escobar G,et al.Hypothyroidism alters the development of radial glial cells in the term fetal and postnatal neocortex of the rat[J].Brain Res Dev Brain Res,2004,153(1):109-114
[16]Calil-Silveira J,Serrano-Nascimento C,Laconca RC,et al.Underlying Mechanisms of Pituitary-Thyroid Axis Function Disruption by Chronic Iodine Excess in Rats[J].Thyroid,2016,26(10):1488-1498
[17]Sosi-Jurjevi B,Ajdzanovi V,Filipovi B,et al.Functional morphology of pituitary-thyroid and-adrenocortical axes in middle-aged male rats treated with Vitex agnus castus essential oil[J].Acta Histochem,2016,118(7):736-745
[18]Zuhur SS,Baykiz D,Kara SP,et al.Relationship Among Pulmonary Hypertension,Autoimmunity,Thyroid Hormones and Dyspnea in Patients With Hyperthyroidism[J].Am J Med Sci,2017,353(4):374-380
[19]Ashwini S,Bobby Z,Sridhar MG,et al.Insulin Plant(Costus pictus)Extract Restores Thyroid Hormone Levels in Experimental Hypothyroidism[J].Pharmacognosy Res,2017,9(1):51-59
[20]Badihian S,Jalalpour P,Mirdamadi M,et al.Quality of Life,Anxiety and Depression in Patients with Differentiated Thyroid Cancer under Short Term Hypothyroidism Induced by Levothyroxine Withdrawal[J].Klin Onkol,2016,29(6):439-444
[21]Dayan CM,Panicker V.Hypothyroidism and depression[J].Eur Thyroid J,2013,2(3):168-179
[22]Krysiak R,Szkróbka W,OkopieńB.The effect of l-thyroxine treatment on sexual function and depressive symptoms in men with autoimmune hypothyroidism[J].Pharmacol Rep,2017,69(3):432-437
[23]Bathla M,Singh M.Reply to"How prevalent are depression and anxiety symptoms in hypothyroidism?"[J].Indian J Endocrinol Metab,2016,20(6):883-884
[24]Park YJ,Lee EJ,Lee YJ,et al.Subclinical hypothyroidism(SCH)is not associated with metabolic derangement,cognitive impairment,depression or poor quality of life(Qo L)in elderly subjects[J].Arch Gerontol Geriatr,2010,50(3):e68-e73
[25]Wouters HJ,Van Loon HC,Van der Klauw MM,et al.No Effect of the Thr92Ala Polymorphism of Deiodinase-2 on Thyroid Hormone Parameters,Health-Related Quality of Life,and Cognitive Functioning in a Large Population-Based Cohort Study[J].Thyroid,2017,27(2):147-155
[26]Pasquali D,Carotenuto M,Leporati P,et al.Maternal hypothyroidism and subsequent neuropsychological outcome of the progeny:a family portrait[J].Endocrine,2015,50(3):797-801
[27]Rakhshan M Ph D,Ghanbari A Bs,Rahimi A Ms,et al.A Comparison between the Quality of Life and Mental Health of Patients with Hypothyroidism and Normal People Referred to Motahari Clinic of Shiraz University of Medical Sciences[J].Int J Community Based Nurs Midwifery,2017,5(1):30-37
[28]Sikjaer T,Moser E,Rolighed L,et al.Concurrent Hypoparathyroidism Is Associated With Impaired Physical Function and Quality of Life in Hypothyroidism[J].J Bone Miner Res,2016,31(7):1440-1448
[29]Taieb D,Bournaud C,Eberle MC,et al.Quality of life,clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves'hyperthyroidism undergoing radioiodine therapy:a randomized controlled study[J].Eur J Endocrinol,2016,174(4):491-502
[30]Krysiak R,Szkróbka W,OkopieńB.The effect of l-thyroxine treatment on sexual function and depressive symptoms in men with autoimmune hypothyroidism[J].Pharmacol Rep,2017,69(3):432-437