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抑郁障碍是最常见的精神障碍,是一类以情绪或心境低落为主要表现的疾病总称,伴有不同程度的认知行为改变[1]。抑郁症的年患病率为7%,15%~25%的病人会反复发作而慢性化[2]。许多抑郁症以躯体不适症状为主要表现,常见有:抑郁症伴失眠、难以表述的躯体不适症状、体质量减轻、食欲减退、循环系统症状、头痛、性功能减退、胃肠道症状和呼吸系统症状等,而且这些症状因病人年龄和性别、所处的医疗环境不同而异[3]。很多病人最初不知道自己所患何病,到处求医,仍无法得到有效诊治,且否认自己的病症是心理疾病伴随的躯体症状,有时会给临床各科医生带来困惑,给病人带来痛苦。抑郁症的抑郁情绪及躯体不适症状的研究受到广泛关注,有人认为其发生与人格因素有关联,使其对情绪反应比较强烈,并可伴有各种病理生理障碍[4]。最近王高华等[5]研究显示,抑郁症病人有明显负性注意偏向,它可能通过被束缚状态的中介机制影响躯体不适和抑郁症状,这给抑郁症的躯体不适症状的病理生理机制研究提供了新的线索。我们注意到抑郁症发病的人格因素与注意偏向、被束缚的相关机制仍没有完全阐明,深入研究抑郁症的躯体不适的形成与注意偏向、被束缚的关联,同时探讨抑郁症的人格特征与它们的相互关系,可能对抑郁症伴随躯体不适症状的发生机制研究具有重大意义。
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抑郁组SSTN、ANI、HAMD和SSS总分均明显高于对照组(P < 0.01),API总分低于对照组(P < 0.01)(见表 1)。
分组 n SSTN API ANI HAMD SSS 抑郁组 85 58.62±10.44 39.87±9.34 36.82±7.50 21.79±7.84 56.08±11.88 对照组 93 36.58±7.28 51.67±5.59 27.47±4.71 0.70±1.24 27.98±6.96 t — 16.45 10.33 10.05 25.61 19.46 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 表 1 2组SSTN、API、ANI、HAMD、SSS评分比较(x±s;分)
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抑郁组在人格特质中的P、N评分均明显高于对照组(P < 0.01);2组E和L评分差异均无统计学意义(P>0.05)(见表 2)。
分组 n P E N L 抑郁组 85 65.76±67.13 46.76±11.25 68.59±7.58 39.88±10.49 对照组 93 47.04±5.58 44.57±11.63 52.85±6.10 42.58±8.99 t — 2.68 1.28 15.32 1.85 P — < 0.01 >0.05 < 0.01 >0.05 表 2 2组人格特质EPQ量表的比较(x±s; 分)
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抑郁组病人的HAMD评分与SSS评分呈明显正相关关系(r=0.581,P < 0.01);而HAMD评分、SSS评分与API分均呈负相关关系(r=-0.355、-0.256,P < 0.01和P < 0.05),与ANI评分呈正相关关系(r=0.234、0.393,P < 0.05和P < 0.01),与SSTN评分呈明显正相关关系(r=0.459、0.351,P < 0.01),与N评分呈明显正相关关系(r=0.323、0.327,P < 0.01);同时病人的SSTN评分与ANI评分呈明显正相关关系(r=0.475,P < 0.01);N评分与ANI评分、SSTN评分呈明显正相关关系(r=0.484、0.407,P < 0.01)。
抑郁症的躯体不适与神经质、注意偏向和被束缚的关联研究
Relationship between somatic discomfort and neuroticism, attentional bias and TORAWARE in depression
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摘要:
目的 探讨抑郁症病人躯体不适症状与神经质、注意偏向和被束缚程度之间的相关性,探究抑郁症躯体不适症状发病的心理机制。 方法 选择门诊确诊85例抑郁症病人(抑郁组)和93名健康志愿者(对照组)进行汉密尔顿抑郁量表(HAMD-24)、躯体症状自评量表(SSS)、艾森克人格测试量表(EPQ)、正性负性信息注意量表(APNI)、中文版神经症被束缚自评量表(SSTN)评估,分析其相关关系。 结果 抑郁组躯体症状、被束缚状态、负性注意偏向、抑郁症状评分均明显大于对照组(P < 0.01);对照组的正性注意偏向评分明显高于抑郁组(P < 0.01);抑郁组神经质评分明显高于对照组(P < 0.01);抑郁组神经质和精神质评分均明显高于对照组(P < 0.01)。2组掩饰程度和内外向评分差异均无统计学意义(P>0.05);抑郁组的抑郁程度评分与躯体不适评分呈明显正相关关系(r=0.581,P < 0.01);而抑郁程度评分、躯体不适评分与正性注意偏向评分呈负相关关系(r=-0.355、-0.256,P < 0.01和P < 0.05);与负性注意偏向评分呈正相关关系(r=0.234、0.393,P < 0.05);与被束缚状态评分呈明显正相关关系(r=0.459、0.351,P < 0.01);与神经质评分呈明显正相关关系(r=0.323、0.327,P < 0.01);病人的被束缚评分与负性注意偏向评分呈明显正相关关系(r=0.475,P < 0.01);神经质评分与负性注意偏向评分、被束缚状态评分呈明显正相关关系(r=0.484、0.407,P < 0.01)。 结论 抑郁症病人伴有的躯体不适、抑郁症状与其显著的负性注意偏向增强和正性注意偏向减弱、神经质人格、被束缚状态有关,神经质人格与负性注意偏向、被束缚、躯体不适、抑郁症状之间的交互作用、互相加强,可能是抑郁症躯体不适、抑郁症状发生、发展的重要心理机制之一。 Abstract:Objective o explore the correlation between somatic discomfort and neuroticism, attentional bias and TORAWARE in patients with depression, and to explore the psychological mechanism of somatic discomfort of depression. TMethods A total of 85 patients with depression(depression group) diagnosed in the outpatient department and 93 healthy volunteers(control group) evaluated with Hamilton depression scale(HAMD-24), self-rating scale of somatic symptoms(SSS), Eysenck personality test(EPQ), attention to positive and negative inventory(APNI) and the Chinese version of self-rating scale for the TORAWARE state of neurosis(SSTN).Their relationship was analyzed. Results The scores of somatic symptoms, TORAWARE, negative attentional bias and depressive symptoms in depression group were significantly higher than those in control group(P < 0.01).The scores of positive attentional bias of control group were significantly higher than those in depression group(P < 0.01).The scores of neuroticism and psychoticism in depression group were higher than those in control group(P < 0.01).There were no significant differences in the scores of concealment and introversion and extroversion(P>0.05).There was a positive correlation between depression degree score and somatic discomfort score in depression group(r=0.581, P < 0.01).The scores of depression and somatic discomfort were negatively correlated with the scores of positive attentional biases(r=-0.355, P < 0.01 and P < 0.05).They were significanly positively correlated with negative attentional bias(r=0.234, P < 0.05), TORAWARE score(r=0.459, 0.351, P < 0.01) and neuroticism score(r=0.323, 0.327, P < 0.01).There was a significant positive correlation between TORAWARE score and negative attentional bias score(r=0.475, P < 0.01).Neuroticism score was significantly positively correlated with negative attentional bias score and TORAWARE state score(r=0.484, 0.407, P < 0.01). Conclusions The somatic discomfort and depressive symptoms of patients with depression are related to the increase of negative attentional bias and the decrease of positive attentional bias, neuroticism personality and TORAWARE state.The interaction and mutual reinforcement between neuroticism personality and negative attentional bias, TORAWARE, somatic discomfort and depressive symptoms may be the important psychological mechanisms for the occurrence and development of somatic discomfort and depressive symptoms of depression. -
Key words:
- depression /
- somatic discomfort /
- neuroticism /
- attentional bias /
- TORAWARE
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表 1 2组SSTN、API、ANI、HAMD、SSS评分比较(x±s;分)
分组 n SSTN API ANI HAMD SSS 抑郁组 85 58.62±10.44 39.87±9.34 36.82±7.50 21.79±7.84 56.08±11.88 对照组 93 36.58±7.28 51.67±5.59 27.47±4.71 0.70±1.24 27.98±6.96 t — 16.45 10.33 10.05 25.61 19.46 P — < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 表 2 2组人格特质EPQ量表的比较(x±s; 分)
分组 n P E N L 抑郁组 85 65.76±67.13 46.76±11.25 68.59±7.58 39.88±10.49 对照组 93 47.04±5.58 44.57±11.63 52.85±6.10 42.58±8.99 t — 2.68 1.28 15.32 1.85 P — < 0.01 >0.05 < 0.01 >0.05 -
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