Zhang Y N, Jin C, Ning L, Gong S, Xiao Y, Yu G L
Department of Cardiology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2019 Nov 24;47(11):907-912. doi: 10.3760/cma.j.issn.0253-3758.2019.11.010.
To explore the clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the cardiology department in general hospital. Cross-sectional survey method was used in this study. From August 2017 to September 2018, 508 outpatients of our department with suspected mental disorders, who complained of physical discomfort and screened by the "Three Questions" method recommended by the Chinese Expert Consensus on Psychological Prescriptions of Cardiovascular Patients in 2014, were consecutively included. General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Patient Health Questionnaire-15 (PHQ-15) and self-made general demographic questionnaire (including age, sex, marital status, educational level, occupation, duration of disease, clinical diagnosis and the process of medical treatment for the main somatic symptoms in recent one year) were used to investigate these patients, under the assistance of unified training psychological consultants. The detection rate of anxiety and depression, the degree and distribution of somatization symptoms in outpatients with mental disorders were analyzed, and the related factors affecting the occurrence of somatization symptoms were screened by multivariate logistic regression. The selected patients were (51.3±10.1) years old, of which 37.8% (192/508) were males and 62.2% (316/508) were females. The total detection rate of anxiety/depression was 86.8% (441/508), and the detection rate of somatization symptoms was 93.1% (473/508). The number of positive symptom items in PHQ-15 was 8.0±2.7, and the detection rate of anxiety/depression was 78.6% (372/473) in patients with somatization symptoms. There were significant differences in the proportion of women, the average number of outpatient visits and hospitalizations in the past one year, GAD-7 score and PHQ-9 score among the patients with mild, moderate and severe somatization symptoms (all <0.05). PHQ-15 score was positively correlated with GAD-7 score (0.524 5, 0.001) and PHQ-9 score (0.574 9, 0.001) in patients with somatization symptoms. Stepwise logistic regression analysis showed that total scores of PHQ-9 (8.020, 95 3.470-18.930, 0.001) and GAD-7 (6.526, 95 2.903-13.045, 0.001) and female (4.440, 95 1.059-9.073, 0.011) were related factors of somatizations. The incidence of somatization symptoms is high in patients with psychological disorders in outpatients of cardiology department in general hospital. Anxiety, depression and gender are the main related risk factors of somatization symptoms in this patient cohort. Degree of anxiety and depression increased in proportion to the severity of somatization symptoms. Anxiety, depression and female is related to somatization symptoms.
探讨综合医院心内科门诊精神障碍患者躯体化症状的临床特征及相关因素。本研究采用横断面调查方法。2017年8月至2018年9月，连续纳入我科508例主诉身体不适且经2014年《心血管病患者心理处方中国专家共识》推荐的“三问”法筛查的疑似精神障碍门诊患者。在统一培训的心理咨询师协助下，采用广泛性焦虑量表（GAD-7）、患者健康问卷（PHQ-9）、患者健康问卷-15（PHQ-15）及自制的一般人口学问卷（包括年龄、性别、婚姻状况、文化程度、职业、病程、临床诊断及近一年主要躯体症状的就医过程）对这些患者进行调查。分析精神障碍门诊患者焦虑和抑郁的检出率、躯体化症状的程度及分布情况，并通过多因素logistic回归筛选影响躯体化症状发生的相关因素。入选患者年龄为（51.3±10.1）岁，其中男性占37.8%（192/508），女性占62.2%（316/508）。焦虑/抑郁总检出率为86.8%（441/508），躯体化症状检出率为93.1%（473/508）。PHQ-15阳性症状条目数为8.0±2.7，有躯体化症状患者的焦虑/抑郁检出率为78.6%（372/473）。轻、中、重度躯体化症状患者在女性比例、过去一年门诊及住院平均次数、GAD-7评分及PHQ-9评分方面差异均有统计学意义（均P<0.05）。有躯体化症状患者的PHQ-15评分与GAD-7评分（r=0.524 5，P=0.001）及PHQ-9评分（r=0.574 9，P=0.001）呈正相关。逐步logistic回归分析显示，PHQ-9总分（β=8.020，95%CI 3.47018.930，P=0.001）、GAD-7总分（β=6.526，95%CI 2.90313.045，P=0.001）及女性（β=4.440，95%CI 1.059~9.073，P=0.011）是躯体化的相关因素。综合医院心内科门诊心理障碍患者躯体化症状发生率较高。焦虑、抑郁及性别是该患者群体躯体化症状的主要相关危险因素。焦虑和抑郁程度随躯体化症状严重程度增加而升高。焦虑、抑郁及女性与躯体化症状有关。
