Zhongguo cuzhong zazhi (Jul 2022)
急性缺血性卒中患者住院期间照顾者焦虑抑郁的发生率及影响因素分析 Incidence and Influencing Factors of Anxiety and Depression in Caregivers of Patients with Acute Ischemic Stroke during Hospitalization
Abstract
目的 分析急性缺血性卒中患者的照顾者出现焦虑、抑郁情绪的影响因素，早期识别缺血性卒中照顾者的心理状态，为后续的干预措施提供参考。 方法 连续纳入急性缺血性卒中患者住院期间的照顾者，进行焦虑自评量表（self-rating anxiety scale，SAS）和抑郁自评量表（self-rating depression scale，SDS）评估，根据SAS分值分为焦虑组（SAS≥50分）和非焦虑组（SAS<50分）；根据SDS分值分为抑郁组（SDS≥53分）和非抑郁组（SDS<53分）。收集照顾者的人口学信息、慢性疾病史、婚姻、工作情况以及其照顾患者的卒中严重程度（入院时NIHSS）、慢性疾病史、是否医保、是否存在焦虑（SAS≥50分）和抑郁（SDS≥53分）情绪等资料。对上述指标进行单因素和多因素分析，判断其是否独立影响照顾者的焦虑或抑郁状态。 结果 研究共纳入完成量表评估的照顾者164例（对应的缺血性卒中患者164例），照顾者中男性63例（38.4%），女性101例（61.6%），平均年龄54.2±6.2岁。照顾者焦虑组75例（45.7%），非焦虑组89例（54.3%），焦虑组中女性比例（73.3% vs. 51.7%，P<0.01），有慢性病史比例（77.3% vs. 59.6%，P=0.02）高于非焦虑组，焦虑组中被照顾的患者入院时神经功能缺损更严重（NIHSS≥5分比例：66.7% vs. 48.3%，P=0.02），存在焦虑情绪的比例更高（57.3% vs. 31.4%，P<0.01）。抑郁组59例（36.0%），非抑郁组105例（64.0%）。抑郁组中被照顾的患者入院时神经功能缺损更重（NIHSS≥5分比例：88.1% vs. 39.0%，P=0.01）。多因素logistic回归分析显示女性照顾者（OR 1.041，95%CI 1.020～1.062，P=0.01）及患者的焦虑情绪（OR 1.062，95%CI 1.041～1.083，P=0.03）是照顾者出现焦虑情绪的独立危险因素。 结论 急性期缺血性卒中患者的照顾者焦虑、抑郁情绪发生率较高，照顾者的性别、慢性病史以及患者神经功能缺损的严重程度和患者的焦虑情绪可能影响照顾者的焦虑、抑郁情绪。 Abstract: Objective To analyze the influencing factors of anxiety and depression in the caregivers of patients with acute ischemic stroke (AIS), and identify the psychological state of the caregivers early so as to provide reference for early intervention. Methods This study prospectively enrolled the caregivers of AIS patients during hospitalization. All the subjects completed the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), and they were divided into anxiety group (SAS≥50) and non-anxiety group (SAS<50), depression group (SDS≥53) and non-depression group (SDS<53). Demographic data, history of chronic diseases, marriage, employment of the caregivers and baseline stroke severity (admission NIHSS), health insurance, anxiety and depression state of AIS patients were collected. Multivariate logistic regression analysis was used to determine the factors influencing the caregivers' anxiety or depression state. Results A total of 164 caregivers who completed anxiety and depression assessment were included in this study (corresponding to 164 AIS patients), with an average age of 54.2±6.2 years and 63 males (38.4%). There were 75 cases (45.7%) in anxiety group, 89 (54.3%) in non-anxiety group. The proportion of women (73.3% vs. 51.7%, P<0.01) and chronic disease history (77.3% vs. 59.6%, P=0.02) in anxiety group was higher than that in non-anxiety group. The neurological deficits at admission was more severe (66.7% vs. 48.3% for the proportion of NIHSS≥5 scores, P=0.02) and the proportion of having anxiety was higher (57.3% vs. 31.4%, P<0.01) in the patients who were cared for in anxiety group than those in non-anxiety group. There were 59 cases (36.0%) in depression group and 105 cases (64.0%) in non-depression group. Patients who were cared for in depression group had more severe neurological deficits at admission (88.1% vs. 39.0% for NIHSS≥5, P=0.01) than those in non-depression group. Logistic analysis showed that female caregivers (OR 1.041, 95%CI 1.020-1.062, P=0.01) and patients with anxiety (OR 1.062, 95%CI 1.041-1.083, P=0.03) were independent risk factors for anxiety in caregivers. Conclusions The incidence of anxiety and depression was higher in the caregivers of AIS patients. Female and chronic disease history for caregivers and stroke severity and having anxiety for AIS patients were independent risk factors for anxiety in caregivers.
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