Simson Udo, Perings Christian, Plaskuda Ariane, Schäfer Ralf, Brehm Michael, Bader Doris, Tress Wolfgang, Franz Matthias
Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf.
Psychother Psychosom Med Psychol. 2006 Dec;56(12):493-9. doi: 10.1055/s-2006-951877.
OBJECTIVE It is well known fact, that the life of ICD patients is often affected by anxiety and depression. The number of ICD discharges is only a contributing factor explaining the variance of anxiety and depression. There have to be other factors that have more influence on the physical strain of ICD patients. In this study we examined the impact of attachment style and social support in addition to the number of ICD discharges. METHODS 119 out-patients at an out-patient ICD unit were examined consecutively with the following self report scales: (1) the State-Trait-Anxiety Inventory (STAI), (2) the Beck Depression Inventory (BDI), (3) a short form of a social support questionnaire (F-SOZU), (4) the Bielefeld Partnership Expectations Questionnaire (BFPE) and (5) a specifically designed questionnaire for the assessment of sociodemografic data. To determine the frequency and timing of the ICD discharges we analysed the ICD data. RESULTS 38 % of the ICD patients reported enhanced anxiety levels and 37 % reported enhanced depression levels. Only 38 % of the ICD patients received discharges at all. Elevated levels of anxiety and depression were found in patients who showed insecure attachment styles, low social support, long-term treatment in hospital and a higher number of ICD discharges. To explain the variance of anxiety we found social support, attachment style, and the number of ICD storms to be contributing factors. To explain the variance of depression we found social support and time spent in hospital in the previous year to be contributing factors. CONCLUSIONS Almost half of the ICD patients suffer considerably from anxiety and/or depression. These patients have to be identified and treated psychotherapeutically. Patients who show insecure attachment styles, receive low social support, undergo long-term treatment in hospital and receive a higher number of discharges, especially so called ICD storms, bear the highest risk to develop psychological strain. Attachment style and social support have even more impact on the development of anxiety and depression than the number of ICD discharges. It has to be shown in future studies whether psychotherapy can improve the quality of life of ICD patients.
目的 众所周知，植入式心律转复除颤器（ICD）患者的生活常受焦虑和抑郁影响。ICD放电次数只是解释焦虑和抑郁差异的一个促成因素。必定还有其他因素对ICD患者的身体负担有更大影响。在本研究中，我们除了研究ICD放电次数外，还考察了依恋风格和社会支持的影响。方法 对一家门诊ICD科室的119名门诊患者连续使用以下自我报告量表进行检查：（1）状态-特质焦虑量表（STAI），（2）贝克抑郁量表（BDI），（3）社会支持问卷简表（F-SOZU），（4）比勒费尔德伙伴关系期望问卷（BFPE），以及（5）一份专门设计用于评估社会人口统计学数据的问卷。为确定ICD放电的频率和时间，我们分析了ICD数据。结果 38%的ICD患者报告焦虑水平升高，37%报告抑郁水平升高。只有38%的ICD患者有过放电情况。在表现出不安全依恋风格、社会支持低、长期住院治疗以及ICD放电次数较多的患者中，发现焦虑和抑郁水平升高。为解释焦虑的差异，我们发现社会支持、依恋风格和ICD风暴次数是促成因素。为解释抑郁的差异，我们发现社会支持和前一年的住院时间是促成因素。结论 几乎一半的ICD患者深受焦虑和/或抑郁之苦。必须识别出这些患者并给予心理治疗。表现出不安全依恋风格、社会支持低、长期住院治疗且放电次数较多（尤其是所谓的ICD风暴）的患者，出现心理负担的风险最高。依恋风格和社会支持对焦虑和抑郁发展的影响甚至比ICD放电次数更大。未来研究需表明心理治疗是否能改善ICD患者的生活质量。
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