基于抑郁程度、心理痛苦、自理能力分析的脑卒中后抑郁患者自杀倾向的影响因素探讨  

Influential Factors of Suicide Tendency in Post-stroke Depression Patients Based on Analysis of Depression Severity,Psychological Distress,and Self-care Ability

作　　者：李清金[1] 韩玉惠[1] 洪春永[1] 江华[1] 林庆金 杨雅玲 郑德泉[1] LI Qingjin;HAN Yuhui;HONG Chunyong;JIANG Hua;LIN Qingjin;YANG Yaling;ZHENG Dequan(Department of Neurology,the 909th Hospital Dongnan Hospital of Xiamen University,Zhangzhou,Fujian 363000,China)

机构地区：[1]解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)神经内科,福建漳州363000

出　　处：《临床误诊误治》2024年第5期23-28,共6页Clinical Misdiagnosis & Mistherapy

基　　金：国家级横向课题基金[HX-A-053(2021)];第九〇九医院青年苗圃基金(20YQ010)。

摘　　要：目的调查脑卒中后抑郁(PSD)患者自杀倾向现况,探究基于抑郁程度、心理痛苦、自理能力进一步分析自杀倾向的影响因素。方法选取2021年1月—2023年1月神经内科住院治疗的PSD患者165例,采用MINI自杀筛选问卷评分、健康状况问卷抑郁量表(PHQ-9)评分、心理痛苦温度计(DT)评分、Barthel指数(BI)评分对PSD患者自杀倾向、心理痛苦及病情程度进行评估,并通过一般资料调查问卷收集患者一般情况,采用Pearson法分析MINI评分与PHQ-9评分、DT评分、BI评分的相关性,采用多元线性回归分析PSD患者自杀倾向的影响因素,采用受试者工作特征(ROC)曲线评价各因素及预测模型预测PSD患者自杀倾向的敏感度、特异度,进一步运用部分标准化方法计算各变量重要性。结果165例PSD患者MINI评分(6.65±2.38)分,其中无风险、低风险、中风险、高风险分别占12.12%、24.24%、29.70%、33.94%;PSD患者PHQ-9评分(10.58±3.12)分,DT评分(5.33±2.65)分,BI评分(56.38±6.75)分。MINI评分与PHQ-9评分、DT评分呈正相关,与BI评分呈负相关(P<0.01);多元线性回归分析显示:经济收入、PHQ-9评分、DT评分、简明健康状况量表(SF-36)评分、BI评分、对预后有信心、对治疗效果满意、自杀未遂经历是PSD患者自杀倾向的影响因素(P<0.01);重要性排序前五的因素依次为对预后有信心、BI评分、DT评分、PHQ-9评分、自杀未遂经历;ROC曲线显示各因素及预测模型均具有良好的预测价值。结论对预后有信心、BI评分、DT评分、PHQ-9评分、自杀未遂经历是PSD患者自杀倾向重要性排名前五的影响因素,其余因素有经济收入、SF-36评分、对治疗效果满意,临床可以此为依据展开有针对性、有侧重点的防控措施,以降低PSD患者自杀倾向。Objective To investigate the current status of suicide tendency in patients with post-stroke depression(PSD),and to explore the factors that further influence suicide tendency based on depression severity,psychological distress,and self-care ability.Methods A total of 165 PSD patients who were hospitalized in the Department of Neurology from January 2021 to January 2023 were selected.The suicide tendency,psychological distress,and severity of the disease were evaluated using the Mini-International Neuropsychiatric Interview(MINI)suicide screening questionnaire score,the Patient Health Questionnaire-9(PHQ-9)score,the distress thermometer(DT)score,and the Barthel index(BI)score.The general information of the patients was collected through a general information questionnaire.The Pearson method was used to analyze the correlation between the MINI score and the PHQ-9 score,DT score,and BI score.Multiple linear regression analysis was used to analyze the influencing factors of suicide tendency in PSD patients.The receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of each factor and prediction model for predicting suicide tendency in PSD patients.Further,partial standardization methods were used to calculate the importance of each variable.Results The MINI score of 165 PSD patients was(6.65±2.38)points,of which 12.12%,24.24%,29.70%,and 33.94%were at risk,low risk,medium risk,and high risk,respectively.The PHQ-9 score of PSD patients was(10.58±3.12)points,the DT score was(5.33±2.65)points,and the BI score was(56.38±6.75)points.The MINI score was positively correlated with the PHQ-9 score and DT score,and negatively correlated with the BI score(P<0.01).Multivariate linear regression analysis showed that economic income,PHQ-9 score,DT score,the MOS item short from health survey(SF-36)score,BI score,confidence in prognosis,satisfaction with therapeutic effect,and attempted suicide experience were the influencing factors of suicide tendency in PSD patients(P<0.01).The top fiv

关 键 词：卒中 抑郁 心理痛苦 自理能力 自杀 影响因素分析 相关性 预测价值 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R749.4[医药卫生—临床医学]