Tang Siew Tzuh, Chen Jen-Shi, Chou Wen-Chi, Lin Kuan-Chia, Chang Wen-Cheng, Hsieh Chia-Hsun, Wu Chiao-En
School of Nursing, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan.
Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Support Care Cancer. 2016 Jan;24(1):83-91. doi: 10.1007/s00520-015-2747-0. Epub 2015 May 3.
Terminally ill cancer patients experience progressive functional decline, accelerating symptom severity, deteriorating social support, and self-perceived burden to others (SPB), predisposing them to depressive symptoms. However, changes in the prevalence of severe depressive symptoms as death approaches and the unique roles of these four variables have not been adequately studied. This study explored longitudinal changes in and associations of symptom distress, functional dependence, social support, and SPB with prevalence of severe depressive symptoms in the last year of life.
A convenience sample of 325 cancer patients was longitudinally followed until death. Prevalence of severe depressive symptoms (score ≥11 on the depression subscale of the Hospital Anxiety and Depression Scale) was examined by multivariate logistic regression modeling with the generalized estimating equation.
The prevalence of severe depressive symptoms increased as death approached. The likelihood of severe depressive symptoms was significantly higher in patients who had higher levels of symptom distress and functional dependence, received greater tangible support, and reported high SPB, but lower for patients reporting a higher level of affectionate support and positive social interactions with their supportive network.
Prevalence of severe depressive symptoms increased as death approached and was associated with several modifiable factors. Healthcare professionals should become familiar with these factors to identify vulnerable patients. To decrease the likelihood of terminally ill cancer patients' severe depressive symptoms, they should receive effective interventions to manage their symptoms, appropriately foster social support to restore their fragile self-esteem due to depending on others, and lighten their SPB.
晚期癌症患者会经历功能逐渐衰退、症状严重程度加速、社会支持恶化以及自我感知的他人负担（SPB），这些因素使他们易患抑郁症状。然而，临近死亡时严重抑郁症状的患病率变化以及这四个变量的独特作用尚未得到充分研究。本研究探讨了在生命的最后一年中，症状困扰、功能依赖、社会支持和SPB与严重抑郁症状患病率之间的纵向变化及关联。
对325名癌症患者的便利样本进行纵向随访直至死亡。通过使用广义估计方程的多变量逻辑回归模型来检查严重抑郁症状的患病率（医院焦虑和抑郁量表抑郁分量表得分≥11）。
随着死亡临近，严重抑郁症状的患病率增加。症状困扰和功能依赖程度较高、获得更多实际支持且报告SPB较高的患者出现严重抑郁症状的可能性显著更高，但报告情感支持水平较高且与支持网络有积极社会互动的患者出现严重抑郁症状的可能性较低。
随着死亡临近，严重抑郁症状的患病率增加，且与几个可改变的因素相关。医疗保健专业人员应熟悉这些因素以识别易患患者。为降低晚期癌症患者出现严重抑郁症状的可能性，他们应接受有效的症状管理干预，适当地促进社会支持以恢复因依赖他人而脆弱的自尊，并减轻他们的SPB。
