抑郁症患者躯体化症状体验和认识的质性研究  

Qualitative Research on Somatic Symptoms in Depression

作　　者：陈丽 贾守梅 李萍[2] 李洋 CHEN Li;JIA Shoumei;LI Ping;LI Yang(School of Nursing,Fudan University,Shanghai 200032,China;Putuo Mental Health Center,Shanghai 200065,China)

机构地区：[1]复旦大学护理学院,上海市200032 [2]上海市普陀区精神卫生中心,200065

出　　处：《中国全科医学》2019年第29期3634-3638,共5页Chinese General Practice

基　　金：CMB护理青年教师科研基金项目(13-168-201603)

摘　　要：背景抑郁症患者的躯体化症状发生率为65.0%~98.2%,其严重影响了患者的生活质量。了解患者的经历和体验可以更好地为其提供能满足个体需要的、有针对性的医疗服务,提高患者的生活质量,但目前国内外缺乏对抑郁症患者躯体化症状的体验和认识研究。目的深入了解抑郁症患者对于自身躯体化症状的体验和认识。方法采用描述性质性研究方法,于2017年10-12月采用目的抽样法从上海市某精神专科医院选取符合纳入标准的15例单相抑郁症患者进行半结构式访谈,并采用MAXQDA 10软件,对资料进行整理、编码、分类、归纳、提炼主题。结果提炼出2大主题5个亚主题,包括:(1)患者的躯体症状描述,主要涉及神经肌肉系统、循环呼吸系统、胃肠道系统以及部分无明显系统归类症状;除了明确定位的躯体化症状,患者还存在难以言说或无法准确定位的躯体不适感,躯体不适体验常较客观检查结果严重;(2)患者对躯体化症状的认识,包括对躯体化症状认识不足以及无法将躯体化症状与精神障碍建立联系。结论抑郁症患者的躯体化症状类型多样,轻重各异,给患者带来不良影响,降低患者的生存质量。因此,临床医护人员应加强对抑郁症患者躯体化症状的关注和重视。Background It has been found that 65.0% to 98.2% of patients with depression have somatic symptoms,which severely affect the quality of patients’ life.To understand patients’ experiences can provide better targeted medical services to meet individual needs and improve their quality of life.However,there is a lack of experience and understanding of somatic symptoms in depression at home and abroad.Objective To understand experience of people with depressive disorder about somatic symptoms.Methods Fifteen patients with unipolar depression admitted to a psychiatric hospital in Shanghai from October to December 2017 were selected by sampling method,and a semi-structured interview was conducted by descriptive research.MAXQDA10 software was used to organize,encode,classify,induce and extract the topic.Results Two topics and five subtopics were extracted,including:(1) descriptions of somatic symptoms in patients,which were mainly in the neuromuscular system,circulatory respiratory system,gastrointestinal system and some symptoms without obvious systemic classification;besides located somatic symptoms,patients also had somatic discomforts that were difficult to explain or could not be accurately located.Physical discomfort experience was more severe than the result of objective examinations;(2) patients’ understanding of somatic symptoms,including insufficient understanding of somatic symptoms and the inability to link somatic symptoms to mental disorder.Conclusion Patients with depression who have various types of somatic symptoms with different degrees can bring adverse effects on patients and reduce their quality of life.Therefore,clinical medical staff should pay more attention to the somatic symptoms of patients with depression.

关 键 词：抑郁症 躯体型障碍 症状体验 头晕 失眠症 心悸 质性研究 

分 类 号：R749.41[医药卫生—神经病学与精神病学]