DCPR was used to assess psychosomatic disorders after SARS-Cov-2 in elderly patients with coronary heart disease
-
摘要:
目的 为改善老年冠心病患者的生活质量提供个性化的干预措施,采用心身研究的诊断标准(DCPR)评估老年冠心病患者在感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2)后产生的心身相关障碍程度。 方法 采用简单随机抽样的方法,选取南京医科大学第二附属医院2022年9月—2023年6月收治的101例老年冠心病患者作为研究对象,根据是否感染SARS-CoV-2分组,分为感染组(69例)和未感染组(32例)。采用DCPR量表评估患者目前的心身状态,并使用成组t检验、Wilcoxon秩和检验、χ2检验和logistic回归分析等统计学方法进行分析。 结果 感染组更容易产生抑郁情绪[轻度抑郁:27(39.10%) vs. 5(15.60%);中重度抑郁:9(13.10%) vs. 1(3.10%)]和心身症状[37(53.60%) vs. 25(78.10%),χ2=5.537,P<0.05];2组幸福感总分、睡眠困扰总分、心理困扰总分、异常疾病行为总分比较差异均有统计学意义(P<0.05)。 结论 感染SARS-CoV-2是老年冠心病患者产生心身相关障碍的影响因素之一,利用DCPR可以更全面地评估并有助于及时提出合理、具有针对性的干预措施。 -
关键词:
- 老年人 /
- 冠心病 /
- 严重急性呼吸综合征冠状病毒2 /
- 心身相关障碍 /
- 量表评估
Abstract:Objective To provide individualized interventions aimed at improving the quality of life of elderly patients, the diagnostic criteria for psychosomatic research (DCPR) was used to evaluate the psychosomatic related disorders in elderly patients with coronary atherosclerotic heart disease after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Methods Using random sampling, 101 elderly patients with coronary heart disease admitted to the Second Affiliated Hospital of Nanjing Medical University from September 2022 to June 2023 were selected as the research subjects. According to whether they were infected with SARS-CoV-2, 69 cases were in the infected group and 32 cases were in the uninfected group. The DCPR scale was used to evaluate the current psychosomatic status of the patients, and statistical methods such as group t-test, Wilcoxon rank-sum test, χ2 test, and logistic regression analysis were used to analyze the impact of psychosomatic symptoms on the elderly patients with coronary heart disease after infection with COVID-19. Results The infected group was more likely to develop depressed moods [Mild depression: 27 (39.10%) vs. 5 (15.60%); Moderate to severe depression: 9 (13.10%) vs. 1 (3.10%)]and psychosomatic symptoms [(37 (53.60%) vs. 25 (78.10%), χ2=5.537, P < 0.05]. The differences in the scores of happiness total score, sleep disturbance, psychological distress, and abnormal disorder behavior between the two groups were all statistically significant(P < 0.05). Conclusion Infection with SARS-CoV-2 is one of the influencing factors of psychosomatic disorders in elderly patients with coronary heart disease, DCPR can make a more comprehensive assessment and help to propose reasonable and targeted interventions in time. -
表 1 2组老年冠心病患者基本资料及心身相关障碍各量表比较
Table 1. Comparison of basic situation and various scales of psychosomatic disorders in 2 two groups of elderly patients with coronary heart disease
项目 类别 未感染组(n=32) 感染组(n=69) 统计量 P值 年龄(x±s,岁) 73.28±9.48 71.20±9.53 1.021a 0.310 性别[例(%)] 男性 15(46.88) 31(44.93) 0.033b 0.855 女性 17(53.12) 38(55.07) 婚姻状况[例(%)] 已婚 32(100.00) 63(91.30) 1.607b 0.205 未婚、丧偶或离异 0 6(8.70) 职业[例(%)] 退休 25(78.10) 59(85.50) 0.851b 0.356 在职 7(21.90) 10(14.50) 文化程度[例(%)] 文盲 2(6.30) 2(2.90) -0.595c 0.552 小学 1(3.10) 9(13.00) 初中 5(15.60) 12(17.40) 高中(包括职高和中专) 18(56.30) 33(47.80) 本科(包括大专和高职) 6(18.80) 13(18.80) GAD-7[例(%)] 正常 31(96.90) 56(81.20) -2.147c 0.032 轻度焦虑 1(3.10) 7(10.10) 中度焦虑 0 0 中重度焦虑 0 6(8.70) 重度焦虑 0 0 PHQ-9[例(%)] 正常 26(81.30) 33(47.80) -3.149c 0.002 轻度抑郁 5(15.60) 27(39.10) 中度抑郁 0 0 中重度抑郁 1(3.10) 9(13.10) 重度抑郁 0 0 PSSS[例(%)] 正常 7(21.90) 32(46.40) 5.537b 0.019 存在心身相关障碍 25(78.10) 37(53.60) PSI[M(P25, P75),分] 压力总分 0.00(0.00,1.00) 0.00(0.00,1.00) -0.700c 0.484 幸福感总分 6.00(6.00,6.00) 6.00(5.00,6.00) -2.233c 0.026 睡眠困扰总分 2.00(0.25,3.75) 3.00(1.00,5.00) -2.251c 0.024 心理困扰总分 4.00(2.00,5.00) 6.00(4.00,10.00) -3.928c <0.001 异常的疾病行为总分 0.00(0.00,0.00) 0.00(0.00,2.00) -2.622c 0.009 生活质量总分 3.00(2.25,4.00) 3.00(2.50,3.00) -1.089c 0.276 总体幸福评分 9.00(8.00,10.00) 8.00(8.00,9.00) -1.900c 0.057 注:a为t值,b为χ2值,c为Z值。 表 2 因变量赋值情况
Table 2. Assignment of the dependent variable
因变量 赋值方法 GAD-7 正常=0,轻度焦虑=1,中度焦虑=2,中重度焦虑=3,重度焦虑=4 PHQ-9 正常=0,轻度抑郁=1,中度抑郁=2,中重度抑郁=3,重度抑郁=4 PSSS 正常=0,存在心身相关障碍=1 表 3 是否感染SARS-CoV-2对老年冠心病患者产生心身相关障碍的logistic回归分析
Table 3. Logistic regression analysis of psychosomatic disorders in elderly patients with coronary heart disease caused by SARS-CoV-2 infection
因变量 B SE Waldχ2 P值 OR值 95% CI GAD-7 -1.993 1.067 3.490 0.062 0.136 0.017~1.103 PHQ-9 -1.552 0.510 9.279 0.002 0.212 0.078~0.575 PSSS 1.128 0.491 5.275 0.022 3.089 1.180~8.087 -
[1] CHEN Y, KLEIN S L, GARIBALDI B T, et al. Aging in COVID-19: vulnerability, immunity and intervention[J]. Ageing Res Rev, 2021, 65: 101205. DOI: 10.1016/j.arr.2020.101205. [2] NAPOLI C, TRITTO I, BENINCASA G, et al. Cardiovascular involvement during COVID-19 and clinical implications in elderly patients[J]. Ann Med Surg (Lond), 2020, 57: 236-243. DOI: 10.1016/j.amsu.2020.07.054. [3] 刘洋, 王新芳, 吴京凤, 等. 老年综合评估对高龄冠心病合并焦虑患者生活质量的影响[J]. 中国社区医师, 2022, 38(25): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202225049.htmLIU Y, WANG X F, WU J F, et al. Effect of geriatric comprehensive assessment on the quality of life of elderly patients with coronary heart disease complicated with anxiety[J]. Chinese Community Doctors, 2022, 38(25): 145-147. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYS202225049.htm [4] 包海童, 谈萍, 俞沛文, 等. 基于老年综合评估的2型糖尿病病人衰弱影响因素分析[J]. 实用老年医学, 2022, 36(12): 1264-1268. doi: 10.3969/j.issn.1003-9198.2022.12.019BAO H T, TAN P, YU P W, et al. Analysis of influencing factors of frailty in patients with type 2 diabetes mellitus based on comprehensive assessment of geriatrics[J]. Practical Geriatrics, 2022, 36(12): 1264-1268. doi: 10.3969/j.issn.1003-9198.2022.12.019 [5] 王小娇, 王宁, 崔宏, 等. 应用老年综合评估技术分析老年脑卒中恢复期病人营养状态的影响因素[J]. 实用老年医学, 2022, 36(8): 809-812. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA202208014.htmWANG X J, WANG N, CUI H, et al. The comprehensive geriatric assessment technique was used to analyze the influencing factors of nutritional status of elderly patients recovering from stroke[J]. Practical Geriatrics, 2022, 36(8): 809-812. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLA202208014.htm [6] FAVA G A, SONINO N. The clinical domains of psychosomatic medicine[J]. J Clin Psychiatry, 2005, 66(7): 849-858. doi: 10.4088/JCP.v66n0707 [7] SPITZER R L, KROENKE K, WILLIAMS J B, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7[J]. Arch Intern Med, 2006, 166(10): 1092-1097. doi: 10.1001/archinte.166.10.1092 [8] KROENKE K, SPITZER R L, WILLIAMS J B. The PHQ-9: validity of a brief depression severity measure[J]. J Gen Intern Med, 2001, 16(9): 606-613. doi: 10.1046/j.1525-1497.2001.016009606.x [9] LI L, PENG T, LIU R, et al. Development of the psychosomatic symptom scale (PSSS) and assessment of its reliability and validity in general hospital patients in China[J]. Gen Hosp Psychiatry, 2020, 64: 1-8. doi: 10.1016/j.genhosppsych.2020.01.008 [10] PIOLANTI A, OFFIDANI E, GUIDI J, et al. Use of the Psychosocial Index: a sensitive tool in research and practice[J]. Psychother Psychosom, 2016, 85(6): 337-345. doi: 10.1159/000447760 [11] LEE K, JEONG G C, YIM J. Consideration of the psychological and mental health of the elderly during COVID-19: a theoretical review[J]. Int J Environ Res Public Health, 2020, 17(21): 8098. DOI: 10.3390/ijerph17218098. [12] HAN Q, ZHENG B, DAINES L, et al. Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms[J]. Pathogens, 2022, 11(2): 269. DOI: 10.3390/pathogens11020269. [13] 苗连海, 陈继群, 朱德发, 等. 老年综合评估模式对老年冠心病患者的临床疗效[J]. 中国慢性病预防与控制, 2022, 30(3): 218-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202203013.htmMIAO L H, CHEN J Q, ZHU D F, et al. Clinical efficacy of geriatric comprehensive assessment model in elderly patients with coronary heart disease[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2022, 30(3): 218-220. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB202203013.htm [14] PARLAPANI E, HOLEVA V, NIKOPOULOU V A, et al. A review on the COVID-19-related psychological impact on older adults: vulnerable or not?[J]. Aging Clin Exp Res, 2021, 33(6): 1729-1743. doi: 10.1007/s40520-021-01873-4 [15] SAYINKASAR K, KARAMAN E. Life in lockdown: Social isolation, loneliness and quality of life in the elderly during the COVID-19 pandemic: a scoping review[J]. Geriatr Nurs, 2021, 42(5): 1222-1229. doi: 10.1016/j.gerinurse.2021.03.010 [16] LEE Y, LUI L M W, CHEN L D, et al. Government response moderates the mental health impact of COVID-19: a systematic review and meta-analysis of depression outcomes across countries[J]. J Affect Disord, 2021, 290: 364-377. doi: 10.1016/j.jad.2021.04.050 [17] ARMITAGE R, NELLUMS L B. COVID-19 and the consequences of isolating the elderly[J]. Lancet Public Health, 2020, 5(5): e256. DOI: 10.1016/S2468-2667(20)30061-X. [18] SEPÚLVEDA-LOYOLA W, RODRÍGUEZ-SÁNCHEZ I, PÉREZ-RODRÍGUEZ P, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations[J]. J Nutr Health Aging, 2020, 24(9): 938-947. doi: 10.1007/s12603-020-1500-7 [19] IZQUIERDO M, MERCHANT R A, MORLEY J E, et al. International exercise recommendations in older adults (ICFSR): expert consensus guidelines[J]. J Nutr Health Aging, 2021, 25(7): 824-853. [20] 姚元龙, 史威力, 冯娴, 等. 老年共病的研究管理策略[J]. 中华全科医学, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574YAO Y L, SHI W L, FENG X, et al. Research management strategies for multimorbidity in elderly patients[J]. Chinese Journal of General Practice, 2022, 20(8): 1267-1270. doi: 10.16766/j.cnki.issn.1674-4152.002574