Bambauer Kara Zivin, Zhang Baohui, Maciejewski Paul K, Sahay Neayka, Pirl William F, Block Susan D, Prigerson Holly G
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Ave., 6th Floor, Boston, MA 02215, USA.
Soc Psychiatry Psychiatr Epidemiol. 2006 Oct;41(10):819-24. doi: 10.1007/s00127-006-0103-x. Epub 2006 Jul 24.
We sought to determine mutuality and specificity in rates of mental disorders between advanced cancer patients and their caregivers.
Data from 168 non-genetically related patient-caregiver dyads participating in the multi-site Coping with Cancer (CWC) study were included in this analysis. Multivariate logistic regression analyses were conducted to examine associations between diagnoses of a psychiatric disorder in patients with diagnoses of psychiatric disorders in caregivers, and vice versa, controlling for confounders.
When patients met criteria for any psychiatric diagnosis, then caregivers were 7.9 times (P < 0.0001) more likely to meet criteria for any psychiatric diagnosis, and vice versa. Caregiver Panic Disorder (PD) diagnosis was associated with patient Generalized Anxiety Disorder (GAD). Patient GAD was also associated with caregiver PD. Finally, patient PD was associated with caregiver GAD and caregiver Post-Traumatic Stress Disorder (PTSD).
To our knowledge, this is the first study that demonstrates the mutuality of psychiatric disorders in both advanced cancer patients and their informal caregivers. Specifically, the presence of anxiety disorders in one partner (either caregiver or patient) was associated with a greater likelihood of anxiety disorders in the other. Results suggest that psychiatric distress should be assessed in both patients and their caregivers, and that mental illness in one should raise concern about the possibility of a psychiatric disorder in the other. Results also suggest that targeted interventions to address shared fears and concerns of patients and caregivers might reduce anxiety in the end phases of the patient's illness.
我们试图确定晚期癌症患者及其照顾者精神障碍发生率之间的相互关系和特异性。
本分析纳入了参与多中心“应对癌症（CWC）”研究的168对非基因相关的患者-照顾者二元组数据。进行多变量逻辑回归分析，以检验患者精神障碍诊断与照顾者精神障碍诊断之间的关联，反之亦然，并对混杂因素进行控制。
当患者符合任何精神疾病诊断标准时，照顾者符合任何精神疾病诊断标准的可能性高出7.9倍（P < 0.0001），反之亦然。照顾者惊恐障碍（PD）诊断与患者广泛性焦虑障碍（GAD）相关。患者GAD也与照顾者PD相关。最后，患者PD与照顾者GAD和照顾者创伤后应激障碍（PTSD）相关。
据我们所知，这是第一项证明晚期癌症患者及其非正式照顾者精神障碍相互关系的研究。具体而言，一方（照顾者或患者）存在焦虑症与另一方患焦虑症的可能性更大相关。结果表明，应同时评估患者及其照顾者的精神痛苦，一方的精神疾病应引起对另一方患精神障碍可能性的关注。结果还表明，针对患者和照顾者共同恐惧和担忧的有针对性干预措施可能会在患者疾病末期减轻焦虑。
