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中国全科医学 ›› 2021, Vol. 24 ›› Issue (6): 727-731.DOI: 10.12114/j.issn.1007-9572.2020.00.616

所属专题： 神经系统疾病最新文章合集； 精神卫生最新文章合集

• 专题研究 • 上一篇    下一篇

病耻感与首发卒中患者卒中后抑郁的相关性研究

胡瑞丹1，2，周宏珍1，2*，刘志红3，侯佳坤1，2，刘杨杨1，2，白雪洁1，李牧玲1   

  1. 1.510515广东省广州市，南方医科大学南方医院护理部　2.510515广东省广州市，南方医科大学护理学院　3.510515广东省广州市，广东三九脑科医院神经内科
    *通信作者：周宏珍，主任护师，副教授，博士生导师；E-mail：zhouhz2005@126.com
  • 出版日期:2021-02-20 发布日期:2021-02-20
  • 基金资助:
    基金项目：广州市科技计划项目（201803010084）

Correlation between Stigma and Post-stroke Depression in Initally Diagnosed Stroke Patients　

HU Ruidan1，2，ZHOU Hongzhen1，2*，LIU Zhihong3，HOU Jiakun1，2，LIU Yangyang1，2，BAI Xuejie1，LI Muling1   

  1. 1.Department of Nursing，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China
    2.School of Nursing，Southern Medical University，Guangzhou 510515，China
    3.Department of Neurology，Guangdong 999 Brain Hospital，Guangzhou 510515，China
    *Corresponding author：ZHOU Hongzhen，Chief superintendent nurse，Associate professor，Doctoral supervisor；E-mail：zhouhz2005@126.com
  • Published:2021-02-20 Online:2021-02-20

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摘要： 背景　心理-社会因素是卒中后抑郁（PSD）重要的发病机制之一，病耻感给患者带来的认知、情绪和行为的改变可能与PSD的发生密切相关，却很少被重视。目的　探讨病耻感与首发卒中患者PSD的相关性。方法　采用横断面调查研究设计和便利抽样的方法，选取2019年7—12月就诊于南方医科大学南方医院、广东三九脑科医院神经内科和神经外科的首发卒中患者299例。记录患者人口学资料和卒中病史资料。使用卒中病耻感量表（SSS）、9条目患者健康量表（PHQ-9）、改良Rankin量表（mRS）评估患者卒中后1个月时病耻感、抑郁和神经功能恢复情况。结果　共纳入299例首发卒中患者，完整随访221例，脱落78例。根据PHQ-9评分分组，PSD组65例（29.4%，PHQ-9评分≥5分），非PSD组156例（70.6%，PHQ-9评分为0~4分）。PSD组SSS总分及躯体障碍、社会交往、受歧视经历、自我感受、PHQ-9、mRS评分均高于非PSD组（P<0.05）。相关性分析结果显示，PHQ-9评分与SSS总分及躯体障碍、社会交往、受歧视经历、自我感受、mRS评分呈正相关（rs=0.606、0.319、0.441、0.369、0.616、0.389，P<0.05）。多因素Logistic回归分析结果显示，SSS总分是首发卒中患者发生PSD的影响因素〔OR=1.263，95%CI（1.158，1.379），P<0.05〕。结论　首发卒中患者早期的病耻感对PSD具有一定的预测价值，医护人员和患者家属应采取相应措施，警惕PSD的发生。

关键词: 卒中, 病耻感, 卒中后抑郁, 相关性分析, 预测

Abstract: Background　Psychosocial and scoial factors are important participators in the pathogenesis of post-stroke depression（PSD）.However，the fact that cognitive，emotional and behavioral changes brought by stigma may be closely related to PSD has received little attention.Objective　To explore the correlation between stigma and PSD in initally diagnosed stroke patients.Methods　In this cross-sectional study，by use of convenience sampling，initially diagnosed stroke patients（n=299） were recruited from Neurology and Neurosurgery Departments of Nanfang Hospital，Southern Medical University and Guangdong 999 Brain Hospital from July to December 2019.Socio-demograpchics and stroke-related history were collected.The stigma，depression and severity of disability at the end of 1-month follow-up were evaluated using the Stroke Stigma Scale（SSS），Patient Health Questionnaire-9 （PHQ-9） and modified Rankin Scale （mRS），respectively.Results　78 cases were excluded due to loss to follow-up，other 221 cases who completed the follow-up were included for final analysis.By PHQ-9 score，65（29.4%） and 156（70.6%） were evaluated with and without PSD，respectively.PSD patients experienced higher score of physical impairment，social isolation，discrimination experience，internalized stigma，and scores of SSS，PHQ-9，and mRS than non-PSD patients（P<0.05）.Correlation analysis revealed that PHQ-9 score was positively correlated with score of SSS，physical impairment，social isolation，discrimination experience，internalized stigma，and mRS，respectively（rs=0.606，0.319，0.441，0.369，0.616，0.389，P<0.05）.Multivariate Logistic regression analysis illustrated that score of SSS was an independent associated factor of PSD in initally diagnosed stroke patients〔OR=1.263，95%CI（1.158，1.379），P<0.05〕.Conclusion　Stigma manifested in the early stage of stroke may be used as a predictor of PSD in initally diagnosed stroke patients.So medical workers and family members of the stroke patient should be on fully alert for PSD.

Key words: Stroke, Stigma, Post-stroke depression, Correlation analysis, Forecasting

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