摘要
背景2020年9月印发的《新冠肺炎疫情防控常态化下治愈患者心理疏导工作方案》指出,加强新型冠状病毒肺炎(COVID-19)患者康复后心理状况随访至关重要。目前已有横断面研究发现COVID-19患者康复后心理健康问题频发,但仍缺乏其动态随访研究。目的动态随访调查COVID-19康复患者出院后2周及3个月的心理健康状况及其影响因素。方法选取2020年2-4月于安徽省两家定点医院确诊的COVID-19患者为研究对象;收集一般人口学资料;采用流调中心用抑郁量表(CES-D)、失眠严重指数量表(ISI)、躯体化症状自评量表(SSS)和创伤后应激障碍检查量表(PCL)进行心理健康状况评估。结果发放问卷125份,COVID-19康复患者出院后2周(收回有效问卷121份)的抑郁、失眠、创伤后应激障碍(PTSD)和躯体化症状发生率分别为9.92%(12/121)、26.45%(32/121)、1.65%(2/121)和4.96%(6/121)。出院后3个月(收回有效问卷85份)的抑郁、失眠、PTSD和躯体化症状发生率分别为36.47%(31/85)、83.53%(71/85)、8.24%(7/85)和18.82%(16/85)。COVID-19康复患者出院后2周及出院后3个月时的性别、年龄、健康状况、有无家人心理支持、是否需要心理援助以及是否接受心理援助比较,差异无统计学意义(P>0.05)。COVID-19康复患者出院后2周及出院后3个月时的经济状况、身心是否受损以及是否在乎周围人看法比较,差异有统计学意义(P<0.05)。COVID-19康复患者出院后3个月的CES-D总分、ISI总分、SSS总分和PCL总分均高于出院后2周(P<0.05)。在以抑郁症状为因变量的多元Logistic回归分析中,年龄以及是否需要心理援助是患者出院后2周抑郁症状产生的影响因素(P<0.05)。身心是否受损是患者出院后2周及3个月抑郁症状产生的影响因素(P<0.05)。是否在乎周围人看法是患者出院后3个月抑郁症状产生的影响因素,在乎周围人看法的患者患抑郁症状的可能性是不在乎周围人看法患者的3.997倍〔OR(95%CI)=3.997(1.708,9.351),P=0.001〕。在以失眠症状为因变量的多元Logistic回归分析中,年龄、身心是否受损以及是否需要心理援助是患者出院后2周失眠症状产生的影响因素(P<0.05)。是否在乎周围人看法是患者出院后3个月失眠症状产生的影响因素,在乎周围人看法的患者患失眠症状的可能性是不在乎周围人看法患者的10.255倍〔OR(95%CI)=10.255(2.796,37.611),P<0.001〕。结论COVID-19康复患者出院后存在明显的抑郁、失眠、PTSD和躯体化症状等心理健康问题,且随访期越长症状发生率越高,需要精神科专业人员及早进行心理危机干预。
Background The"Work Plan for Psychological Counseling of Patients Under Normalization of Prevention and Control of New Coronary Pneumonia"in September 2020 pointed out that it is important to strengthen the follow-up of the psychological status of COVID-19 patients after recovery.At present,cross-sectional studies have found that patients have frequent mental health problems after recovery,but there is still a lack of dynamic follow-up studies.Objective A dynamic follow-up survey was conducted to investigate the mental health status and its influencing factors of COVID-19 patientstwo weeks and three months after recovery and discharge.Methods COVID-19 patients diagnosed in two designated hospitals in Anhui Province from February to April 2020 were selected as the research objects,the thegeneral demographic data were collected,and the Streaming Depression Self-Rating Scale(CES-D),Insomnia Severity Index Scale(ISI),Somatization Symptom Self-rating Scale(SSS)and Post-Traumatic Stress Disorder Checklist(PCL)were used for mental health status evaluation.Results One hundred and twenty five questionnaires were distributed.The results showed that the incidences of depression,insomnia,PTSD and somatization symptoms in COVID-19 patients at 2 weeks after discharge were 9.92%(12/121),26.45%(32/121),1.65%(2/121)and 4.96%(6/121),respectively.The incidences of depression,insomnia,PTSD and somatization symptoms at 3 months were 36.47%(31/85),83.53%(71/85),8.24%(7/85)and 18.82%(16/85),respectively.There was no significant difference in gender,age,health status,family support,need for psychological assistance and acceptance of psychological assistance between 2 weeks and 3 months after discharge(P>0.05).There were significant differences in the economic status,physical and mental impairment and care about the views of the people around them at 2 weeks and 3 months after discharge(P<0.05).The total scores of CES-D,ISI,SSS and PCL at 3 months after discharge were higher than those at 2 weeks after discharge(P<0.05).In the Multivariate Logistic regression analysis with depression as the dependent variable,age and the need for psychological assistance were the risk factors of depression at 2 weeks after discharge(P<0.05).Physical and mental impairment was the risk factor of depression at 2 weeks and 3 months after discharge(P<0.05).The risk factor of depression at 3 months after discharge was caring about the views of the people around them.Patients who cared about the views of others were 3.997 times more likely to suffer from depressive symptoms than those who didn't〔OR(95%CI)=3.997(1.708,9.351),P=0.001〕.In the Multivariate Logistic regression with insomnia as the dependent variable,age,physical and mental impairment and the need for psychological assistance were the risk factors of insomnia at 2 weeks after discharge(P<0.05).The risk factor of insomnia at 3 months after discharge was caring about the views of the people around them or not.Patients who cared about the views of others were 10.255 times more likely to suffer from insomnia than those who didn't〔OR(95%CI)=10.255(2.796,37.611),P<0.001〕.Conclusion After recovery and discharge,COVID-19 patients have obvious mental health problems such as depression,insomnia,post-traumatic stress disorder and somatization symptoms,and the longer the follow-up period,the higher the incidence of symptoms.Psychiatric professionals need to carry out psychological crisis intervention as soon as possible.
作者
王茜鑫
曹洁
杨延国
徐飞
夏磊
胡晓文
刘寰忠
WANG Xixin;CAO Jie;YANG Yanguo;XU Fei;XIA Lei;HU Xiaowen;LIU Huanzhong(Department of Psychiatry,Chaohu Hospital of Anhui Medical University,Hefei 238000,China;School of Mental Health and Psychological Sciences,Anhui Medical University,Hefei 238000,China;Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of University of Science and Technology/Anhui Provincial Hospital,Hefei 238000,China;Department of Respiratory Medicine,Anqing Hospital affiliated to Anhui Medical University,Anqing 246000,China)
出处
《中国全科医学》
CAS
北大核心
2021年第26期3343-3348,共6页
Chinese General Practice
基金
2019年度国家临床重点专科能力建设项目
中国科学院临床研究医院(合肥)新型冠状病毒肺炎攻关项目(YD9110002004)。
