摘要
目的:分析脑外伤后出院回归社会患者远期迟发性抑郁发病与社会支持的相关性。方法:选择2002-05/2003-05在中国医科大学第四临床学院神经外科门诊就诊和住院治疗的脑外伤患者106例为调查对象。脑外伤发病后1年接受汉密顿抑郁量表和社会支持评定量表测评。采用汉密顿抑郁量表(包括:躯体化;体重变化;认知障碍;昼夜变化;迟缓;睡眠障碍;绝望感7个方面24项内容,采用5级评分,即0无、1轻度、2中度、3重度和4极重度。抑郁测试总得分>8分为抑郁状态,>20分为中度抑郁,>35分为重度抑郁)评估抑郁状态。以汉密顿抑郁量表为分组依据,分为无抑郁组(n=115)和迟发性抑郁组(n=31)。采用社会支持评定量表(包括主观支持、客观支持、个人利用度3个维度10个项目)评定患者自我感觉获得的和实际获得的支持情况及个人利用别人支持和帮助的程度。采用统一指导用语,于发病后1年进行检测。问卷应由测试对象自行填写。当场收回。组间显著性检测采用t检验。结果:①脑外伤患者146例出院1年后,迟发性抑郁患病率为21.2%(31例),无抑郁患者115例(78.7%)。迟发性抑郁组患者社会支持总分明显低于无抑郁组犤(37.41±10.53),(42.73±12.18),t=2.634,P<0.05犦。平均年龄明显大于无抑郁组犤(46.96±13.51),(40.22±14.08)岁,t=3.327,P<0.01犦,但两组患者的性别和文化程度等数据分布接近。②脑外伤后迟发性抑郁组患者主观支持各条目得分(您与朋友,您与邻居,您与同事,您与家庭成员)及主观支持总分均明显低于无抑郁组(t=2.262～3.211,P均<0.01～0.05)。③脑外伤后迟发性抑郁组患者客观支持条目得分(遇到困难时获得的经济来源,精神安慰来源及客观支持总分均明显高于无抑郁组(t=2.237～3.428,P<0.05～0.01),但两组间“近1年对外联系”条目得分无明显区别(P>0.05)。④脑外伤后迟发性抑郁组患者个人利用度条目(您遇到烦恼时的倾吐方式,求助方式)评分及总分均明显低于无抑郁组(t=2.237～3.428,P均<0.05～0.01),但两组间“参加各类团体组织活动”条目无明显区别。结论:本调查结果说明脑外伤回归社会患者的社会支持与迟发性抑郁患病呈负相关,拥有较多社会支持的脑外伤出院回归社会患者社会功能较好。因此寻求增加社会支持的可降低其患病率。
AIM： To analyze the correlation between the attack of delayed depression after cerebral trauma and social supports in the patients after discharge and return to the society. METHODS： Totally 106 outpatients and inpatients with cerebral trauma in the Department of Neurosurgery, the Fourth Clinical Hospital of China Medical University from May 2002 to May 2003 were involved in the analysis of results. The patients were assessed with Hamilton depression scale and social support rating scale one year after the attack of cerebral attack. Their depressive status was evaluated with Hamilton depression scale （consisted of 7 aspects of somatization, change of body mass, cognitive dysfuction, circadian change, retardation, sleep disorder and feeling of despair, including 24 items, scored by 5 grades of 0 to 4：0 as none, 1 as mild, 2 as moderate, 3 as severe, 4 as extremely severe; the total score 〉 8 points as depressive state, 〉 20 points as moderate depression, 〉 35 as severe depression）. According to the score of Hamilton depression scale, the patients were divided into without depression group （n=115） and delayed depression group （n=31）. Their self-feh and actually obtained support, and degree of individual utilization of support and help from others were evaluated with the social support rating scale （consisted of 3 dimensions of subjective support, objective support and individual utilization, including 10 items）. The patients were tested at 1 year after attack under the unified instructions; the questionnaires were filled by the subjects, and collected back on the spot. Intergroup difference was analyzed with the t test. RESULTS： ① Of the 146 patients with cerebral trauma at 1 year after disehare, the prevalence rate of delayed depression was 21.2% （31 cases）, while 115 patients （78.7%） had no depression. The total score of social support in the delayed depression group was obviously lower than in the without depression group （37.41±10.53, 42.73±12.18, t=2.634, P 〈 0.05）, the average age was obviously older than that in the without depression group [（46.96±13.51）, （40,22±14.08） years, t=3.327, P 〈 0.01], but there were insignificant differences in the gender and educational level between the two groups. ② The scores of the items （you and friends, you and neighbor, you and partner, you and family member） for subjective support and the total score of subjective support were obviously lower in the patients of the delayed depression after cerebral trauma group than in the without depression group （t=2.262 to 3.211, P 〈 0.01 to 0.05）, ③ The scores of the items （economic source and source of mental comfort when encountered difficulties） and the total score of objective support were all obviously higher in the patients of the delayed depression after cerebral trauma group than in the without depression group （t=2.237 to 3,428; P 〈 0.05 to 0,01）, but the score of the item “external contact in the last year” was not obviously different between the two groups （P 〉 0.05）. ④ The scores of the items （style of unbosoming and style of seeking help） and the total score of individual utilization were obviously lower in the patients of the delayed depression after cerebral trauma group than in the without depression group （t=2.237 to 3.428, P 〈 0.05 to 0,01）, but there was insignificant difference in the item score of “participating in activities of all kinds of corporation and organization”between the two groups. CONCLUSION： It is suggested that the social support has negative correlation with the prevalence of delayed depression after cerebral trauma in the patients returned to the society, the social function is better in the patients after discharge and returned to the society, who has obtained more social supports, so the seek for the increase of social supports can reduce the prevalence.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期1-3,共3页
Chinese Journal of Clinical Rehabilitation
