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Physical Illnesses and Psychological Characteristics of Outpatients with Multiple Somatic Symptoms in a General Hospital
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摘要:
目的 了解综合医院门诊多躯体症状患者的躯体疾病和精神心理特点, 并探讨其相关因素。 方法 2012年3月至10月采用方便取样的方法, 对北京协和医院消化内科、中医科和心理医学科门诊候诊患者通过躯体症状严重程度量表(somatic symptom scale of the Patient Health Questionnaire, PHQ-15)进行连续筛查。依据PHQ-15分数≥ 10或 < 10, 将患者分为多躯体症状组(SOM+组)和对照组(SOM-组)。每科各组均纳入25例患者, 共纳入150例患者。所纳入患者均完成7份自评问卷及结构化半定式访谈, 包括过去12个月所患躯体疾病和简明国际神经精神访谈。 结果 SOM+组患者女性(69.3%比53.3%)和低于大学文化程度者(54.8%比43.2%)所占比例较SOM-组更高(P < 0.05)。SOM+组患者并未发现患有更多的可明确诊断的躯体疾病; 而其抑郁发作、广泛性焦虑障碍和疑病症的患病率以及抑郁症状严重程度量表(depression scale of the Patient Health Questionnaire, PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder 7-item scale, GAD-7)、健康焦虑量表(Whiteley-7 scale, WI-7)得分均显著高于SOM-组(P均 < 0.05), 其日常生活和就医行为受症状影响更显著(P均 < 0.01)。对多躯体症状预测因素进行Logistic回归分析(P < 0.01, 调整R2=0.53), 发现PHQ-9和WI-7总分高以及没有职业为影响因素。 结论 多躯体症状患者并未发现伴有更多可明确诊断的躯体疾病; 此类患者的焦虑及抑郁程度更高, 生活质量更低, 且其症状对日常生活和就医影响更大; 抑郁和健康焦虑水平高及没有职业是多躯体症状的预测因素。 -
关键词:
- 多躯体症状 /
- 躯体症状障碍 /
- 躯体症状严重程度量表
Abstract:Objective To explore the physical diseases and psychological characteristics of patients with multiple somatic symptoms in the outpatient departments in a general hospital. Methods This cross-sectional study was conducted from March to October, 2012. The participants were recruited through convenience sampling from the outpatient departments of Gastroenterology, Traditional Chinese Medicine, and Psychological Medicine in Peking Union Medical College Hospital. Patients in the waiting list were screened continuously by the somatic symptom scale of the Patient Health Questionnaire (PHQ-15). With the cut-off value of 10, patients were divided into the somatic symptom positive (SOM+) group and the control (SOM-) group. With 25patients enrolled for eachgroup from all these three departments, totally 150 patients were included. All the subjects completed seven self-assessment questionnaires including PHD-15, depression scale of the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), 12-item Short Form Health Survey (SF-12), Whiteley-7 Index (WI-7), Sense of Coherence scale(SOC-9), and health care used and health status scales, and received semi-structured interviews including the diagnosed physical and psychological illnesses during the past 12 months and the Mini-International Neuropsychiatric Interview (MINI). Results The proportions of females and subjects with an education degree below college were significantly higher in SOM+ group than in SOM-group (69.3% vs 53.3%, 54.8% vs 43.2%, respectively; both P < 0.05). While no more physical illness was diagnosed in the past 12 months in the SOM+ group. The prevalence of depression, generalized anxiety disorder, and hypochondriasis and the scores of PHQ-9 and WI-7 were significantly higher in the SOM+ group (P < 0.05). The behavior and daily activities of SOM+ group patients were also more likely to be influenced by their discomforts (P < 0.01). Finally, Logistic regression analysis showed that the high scores of PHQ-9 and WI-7 and unemployment were the influential factors of these manifestations. Conclusions Patients with multiple somatic symptoms do not have more physical illnesses that can be clearly diagnosed. However, they have more psychological distress and lower quality of life, and are more likely to be affected by the symptoms. The high degree of depression and anxiety and unemployment were the influential factors for multiple somatic symptoms. -
表 1 两组患者过去12个月所诊断躯体疾病比较[例(%)]
组别 高血压 糖尿病 关节炎/
风湿病偏头痛 椎间盘突出 心脏病 哮喘/慢性
支气管炎胃肠道
疾病肝炎 肝肾疾病 甲状腺疾病 肿瘤/癌症 脑卒中 神经衰弱 肠易激
综合征纤维
肌痛艾滋病 躯体疾病数目
[M(Q1，Q3)]躯体疾病
阳性SOM-组(n=73)* 9(12.3) 4(5.5) 5(6.8) 3(4.1) 10(13.7) 5(6.8) 1(1.4) 29(39.7) 0 5(6.8) 5(6.8) 0 1(1.4) 5(6.8) 3(4.1) 0 0 1(0, 2) 46(63.0) SOM+组(n=75) 13(17.3) 4(5.3) 11(14.7) 3(4.0) 16(21.3) 9(12.0) 3(4.0) 36(48.0) 5(6.7) 16(21.3) 4(5.3) 4(5.3) 1(1.3) 12(16.0) 3(4.0) 0 0 2(0, 3) 56(74.7) 合计(n=148) 22(14.9) 8(5.4) 16(10.8) 6(4.1) 26(17.6) 14(9.5) 4(2.7) 65(43.9) 5(3.4) 21(14.2) 9(6.1) 4(2.7) 2(1.4) 17(11.5) 6(4.1) 0 0 1(0, 2) 102(68.9) P值 0.392 1 0.126 1 0.222 0.284 0.620 0.311 0.058 0.012 0.744 0.120 1 0.081 1 - - 0.093 0.126 *本组2例数据缺失 
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表 2 两组患者心理状态特征比较[M(Q1，Q3)或( $ \overline x \pm s $)]
组别 PHQ-9总分 GAD-7总分 SF-12评分 WI-7总分 SOC-9总分 PCS维度 MCS维度 SOM-组(n=75) 4.0(2.0, 7.0) 2.0(0, 8.0) 44.8±8.0 45.3±11.6 3.0(1.0, 4.0) 45.8±5.6 SOM+组(n=75) 11.0(7.0, 17.0) 7.0(4.0, 14.0) 39.5±7.9 37.7±12.1 6.0(4.0, 6.0) 41.1±12.0 P值 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.008 PHQ-9：抑郁症状严重程度量表；GAD-7：广泛性焦虑量表；SF-12：12项健康调查简表；PCS：躯体健康总评；MCS：精神健康总评；WI-7：健康焦虑量表；SOC-9：心理一致感量表；SF-12中PCS和MCS及SOC-9分数越高表明情况越好，其余量表分数越高表明情况越差
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表 3 多躯体症状的预测因素Logistic回归分析结果
因素 回归系数 回归系数
标准误P值 OR值(95% CI) PHQ-9总分 0.25 0.05 < 0.001 1.27(1.15~1.42) WI-7总分 0.41 0.12 < 0.001 1.50(1.18~1.90) 有职业 -1.20 0.49 0.015 0.30(0.11~0.79) 截距 -2.70 0.59 < 0.001
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