Department of Rheumatology, Sint Maartenskliniek Nijmegen, The Netherlands.
J Psychosom Res. 2012 Mar;72(3):199-204. doi: 10.1016/j.jpsychores.2011.12.005. Epub 2012 Jan 16.
The prevalence of depressive symptoms is high in patients with systemic sclerosis (SSc, scleroderma). This study was conducted to determine which disease-related and psychosocial factors are associated with depressive symptoms, independent of sociodemographic factors.
In total, 215 patients with SSc completed questionnaires on sociodemographics, physical functioning (HAQ-DI), pain (VAS), fatigue (CIS), psychosocial characteristics (CISS, ICQ, PRQ, ASE, FoP-Q-SF) and depressive symptoms (CES-D). Disease characteristics (disease duration, disease subtype, modified Rodnan Skin Score) were collected. Hierarchical linear regression analyses were conducted to assess associations with depressive symptoms.
The mean CES-D score was 12.9 (SD=9.7) and the prevalence of patients scoring>= 16 and>=19 were 32.1% and 25.1%, respectively. The variance explained by sociodemographics and disease characteristics was negligible (R(2)≤.09). Fatigue and pain were independently associated with depressive symptoms (R(2) change=.35). After adding psychological factors (R(2) change=.21), satisfaction with social support, emotion-focused coping and helplessness were also significantly associated with depressive symptoms. Higher fear of progression was associated with more depressive symptoms (P≤.01), and appearance self-esteem showed a marginally significant association (P=.08).
Depressive symptoms were common in the present sample of patients with SSc and were independently associated with pain, fatigue, social support, emotion-focused coping, helplessness and fear of progression. Results suggest that, in addition to assessment of disease characteristics, attention should be given also to psychosocial factors found to be associated with depressive symptoms. For the development and trialling of psychological interventions, fear of progression could be an important target.
系统性硬化症（SSc，硬皮病）患者的抑郁症状高发。本研究旨在确定哪些与疾病相关和心理社会因素与抑郁症状相关，而与社会人口统计学因素无关。
共有 215 名 SSc 患者完成了社会人口统计学、身体机能（HAQ-DI）、疼痛（VAS）、疲劳（CIS）、心理社会特征（CISS、ICQ、PRQ、ASE、FoP-Q-SF）和抑郁症状（CES-D）的问卷。收集了疾病特征（疾病持续时间、疾病亚型、改良 Rodnan 皮肤评分）。进行了层次线性回归分析，以评估与抑郁症状的关联。
平均 CES-D 得分为 12.9（SD=9.7），得分>=16 和>=19 的患者比例分别为 32.1%和 25.1%。社会人口统计学和疾病特征解释的方差可忽略不计（R²≤.09）。疲劳和疼痛与抑郁症状独立相关（R²变化=.35）。加入心理因素后（R²变化=.21），对社会支持的满意度、情绪聚焦应对和无助感也与抑郁症状显著相关。对进展的恐惧越高与更多的抑郁症状相关（P≤.01），而外表自尊则呈边缘显著关联（P=.08）。
本研究中 SSc 患者的抑郁症状较为常见，与疼痛、疲劳、社会支持、情绪聚焦应对、无助和对进展的恐惧独立相关。结果表明，除了评估疾病特征外，还应关注与抑郁症状相关的心理社会因素。对于心理干预的开发和试验，对进展的恐惧可能是一个重要的目标。
