老年抑郁症病人述情障碍、社会支持对快感缺失与抑郁症状的影响  

Effects of alexithymia and social support on anhedonia and depressive symptoms in elderly patients with late⁃life depression

作　　者：张建 江晨光 袁勇贵[2] ZHANG Jian;JIANG Chenguang;YUAN Yonggui(Department of Psychiatry,Hai’an Third People’s Hospital,Nantong 226600,China;Department of Psychosomatic and Psychiatry,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]海安市第三人民医院精神科,江苏省南通市226600 [2]东南大学附属中大医院心身医学科,江苏省南京市210009

出　　处：《实用老年医学》2024年第10期997-1001,共5页Practical Geriatrics

基　　金：2019年省级重点研发计划专项资金(社会发展)项目(BE2019748)。

摘　　要：目的探讨老年抑郁症(LLD)病人述情障碍与社会支持对快感缺失及抑郁症状的影响。方法选取2020—2023年在东南大学附属中大医院心身医学科病房及门诊就诊的216例年龄≥60岁的LLD病人。采用17项汉密尔顿抑郁量表(HAMD-17)、斯奈思-汉密尔顿快感缺失量表(SHAPS)、多伦多述情障碍量表(TAS)和社会支持评定量表(SSRS)对所有病人进行评估。使用Pearson相关分析探讨量表之间的关联。构建包含LLD病人社会支持、述情障碍、快感缺失、抑郁症状的结构方程模型并进行路径分析。结果TAS得分与HAMD-17(r=0.294,P<0.001)、SHAPS得分(r=0.455,P<0.001)呈正相关,与SSRS得分(r=-0.210,P=0.002)呈负相关;SSRS得分与HAMD-17(r=-0.299,P<0.001)、SHAPS(r=-0.230,P=0.001)得分呈负相关。路径分析结果显示,述情障碍越严重,抑郁症状和快感缺失越严重;社会支持越少,述情障碍、抑郁症状和快感缺失越严重。最终模型的拟合优度良好(χ2=0.211,df=1,χ2/df=0.211,RMSEA<0.001,CFI=1.000,GFI=1.000)。结论提高LLD病人的社会支持水平可以减轻述情障碍和抑郁症状,改善病人的整体心理健康状况。Objective To investigate the effects of alexithymia and social support on anhedonia and depressive symptoms in the elderly patients with late⁃life depression(LLD).Methods A total of 216 elderly LLD patients aged≥60 years who visited Psychosomatic Medicine Department of Zhongda Hospital,Southeast University,from 2020 to 2023 were assessed using the 17⁃item Hamilton Depression Rating Scale(HAMD⁃17),the Snaith⁃Hamilton Pleasure Scale(SHAPS),the Toronto Alexithymia Scale(TAS),and the Social Support Rating Scale(SSRS).The relationships of the variables were explored by Pearson correlation analysis.The structural equation model(SEM)containing alexithymia,social support,anhedonia and depressive symptoms was constructed and analyzed by path analysis.Results The score of TAS was positively correlated with the scores of HAMD⁃17(r=0.294,P<0.001)and SHAPS(r=0.455,P<0.001),and negatively correlated with the score of SSRS(r=-0.210,P=0.002).The score of SSRS was negatively correlated with the scores of HAMD⁃17(r=-0.299,P<0.001)and SHAPS(r=-0.230,P=0.001).The path analysis showed that the more severe alexithymia,the more severe depressive symptoms and anhedonia,while lower level of social support was associated with more severe alexithymia,depressive symptoms,and anhedonia.The final model showed good fit(χ2=0.211,df=1,χ2/df=0.211,RMSEA<0.001,CFI=1.000,GFI=1.000).Conclusions Enhancing social support can mitigate alexithymia and depressive symptoms,thereby improving the overall psychological health of LLD patients.

关 键 词：老年抑郁症 述情障碍 社会支持 抑郁症状 快感缺失 结构方程模型 

分 类 号：R749.4[医药卫生—神经病学与精神病学]