综合医院躯体症状障碍患者的生活质量及其影响因素分析  

Quality of life and the influencing factors in patients with somatic symptom disorders in general hospital

作　　者：吴珩[1] 李涛[2] 陈亦笑 马希权[3] 张岚[4] 张耀尹 陈华 李闻天 任洁 卢伟[9] 魏镜 Kurt Fritzsche Wu Heng;Li Tao;Chen Yixiao;Ma Xiquan;Zhang Lan;Zhang Yaoyin;Chen Hua;Li Wentian;Ren Jie;Lu Wei;Wei Jing;Fritzsche Kurt(Department of Psychosomatic Medicine,Tongji Hospital,School of Medicine,Tongji University,Shanghai 200065,China;Department of Psychological Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences Beijing 100730,China;Department of Psychosomatic Medicine,Dongfang Hospital,School of Medicine,Tongji University,Shanghai 210012,China;Mental Health Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Psychosomatic Medicine,Sichuan Provincial People′s Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Department of Psychological Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Clinic Psychology,Wuhan Mental Health Center,Wuhan 430012,China;Department of Rehabilitation,General Hospital of Jincheng Anthracite Coal Mining Group Co.Ltd,Jincheng 048006,China;Department of Psychosomatic Medicine,Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing 100010,China;Department of Psychosomatic Medicine and Psychotherapy,Freiburg University Medical Center,Freiburg 79104,Germany)

机构地区：[1]同济大学附属同济医院心身医学科,上海200065 [2]中国医学科学院北京协和医院心理医学科,100730 [3]同济大学附属东方医院心身医学科,上海210012 [4]四川大学华西医院心理卫生中心,成都610041 [5]电子科技大学附属四川省人民医院心身医学科,成都610072 [6]复旦大学附属中山医院心理医学科,上海200032 [7]武汉精神卫生中心临床心理科,430012 [8]山西晋城无烟煤矿业集团有限公司总医院康复科,048006 [9]首都医科大学附属北京中医医院心身医学科,100010 [10]德国弗莱堡大学医学中心心身医学及心理治疗科,弗莱堡79104

出　　处：《中华精神科杂志》2021年第3期190-196,共7页Chinese Journal of Psychiatry

摘　　要：目的探讨躯体症状障碍(somatic symptom disorder,SSD)患者的生活质量及其影响因素。方法采取方便取样法,于2016年5月至2018年1月在北京、上海、成都、武汉、晋城的9家三级综合医院的门诊连续纳入患者,经结构化访谈纳入SSD患者236例,采集患者的人口学资料、生活方式及就诊行为、治疗满意度和主观治疗效果等信息,采用12项健康调查简表(12-item medical outcomes study short form health survey,SF-12)、患者健康问卷躯体症状群量表(Patient Health Questionnaire-15,PHQ-15)、躯体症状障碍诊断B标准量表(Somatic Symptom Disorder-B Criteria Scale,SSD-12)评估生活质量、躯体症状严重程度以及对躯体症状的认知、感受和行为,并根据SSD-12评分将患者分为高分组(SSD-12≥16分,n=56)和低分组(SSD-12>16分,n=180),2组间计量资料比较采用t检验、Mann-Whitney U检验,计数资料比较采用卡方检验,采用Pearson相关、多重线性回归分析SSD患者生活质量的影响因素。结果与低分组比较,高分组患者担忧躯体不适时间更长[1.0(0.5,2.0)h/d与3.0(1.0,8.0)h/d,Z=-5.928,P<0.01]、治疗满意度更差[(3.4±1.4)分与(2.2±1.8)分,t=4.073,P<0.01]、主观治疗效果更差[(3.3±1.4)分与(2.2±1.5)分,t=4.353,P<0.01],躯体及心理负担更重,生活质量更低;Pearson相关分析显示,SSD患者的生活质量与抑郁症状严重程度(r=-0.662,P<0.01)、症状相关的认知行为(r=-0.603,P<0.01)呈强相关,与躯体症状数量和严重程度(r=-0.477,P<0.01)呈弱相关。多重线性回归分析显示,抑郁症状严重程度、与症状相关的认知行为对SSD患者的生活质量有显著影响,可解释生活质量61.7%的变异(调整后R2=0.580,P<0.05)。结论SSD患者的抑郁症状严重程度及对躯体症状的认知、感受和行为是其生活质量受损的重要影响因素,应引起重视并积极干预。Objective To explore the quality of life and its influencing factors in patients with somatic symptom disorder(SSD).Methods Patients were recruited from the outpatient departments of cardiology,neurology,gastroenterology,traditional Chinese medicine and psychiatry.SSD patients were included through structured interviews.Demographic data,lifestyle and medical treatment behavior,treatment satisfaction and subjective treatment effect were collected.Participant′s quality of life,severity of somatic symptoms,and thoughts,feelings,and behaviors associated to the somatic symptoms were evaluated by the 12-item medical outcomes study short form health survey(SF-12),Patient Health Questionnaire-15(PHQ-15),and Somatic Symptom Disorder-B Criteria Scale(SSD-12).Patients were divided into high score group(SSD-12≥16,n=56)and low score group(SSD-12>16,n=180).T-test and Mann-Whitney U tests were used to compare the measurement data,and chi-square tests were used to compare the categorical data.Pearson correlation analysis and multiple linear regression was used to analyze the factors affecting the quality of life of SSD.Results Compared to the low score group,patients in high score group were more worried about physical discomfort(1.0(0.5,2.0)h/d vs.3.0(1.0,8.0)h/d,t=-4.6,P<0.01),less satisfied with the treatment((3.4±1.4)score vs.(2.2±1.8)score,t=4.073,P<0.01),and had lower evaluation to the treatment effect((3.3±1.4)score vs.(2.2±1.5)score,t=4.353,P<0.01).High score patients have a heavier physical and psychological burden and lower quality of life.Pearson correlation analysis showed that quality of life(SF-12)was strongly associated with depression(r=-0.662,P<0.01)and symptom-related cognitive behavior(r=-0.603,P<0.01),and it was weakly associated with somatic symptom severity(r=-0.477,P<0.01).Multiple regression analysis showed that depressive and symptom-related cognitive behaviors had a significant influence on quality of life,which explained 58%of the overall variation(P<0.05).Conclusion Depressive level and though

关 键 词：躯体型障碍 躯体症状障碍 生活质量 

分 类 号：R749.2[医药卫生—神经病学与精神病学]