县域医共体早期识别老年高血压患者焦虑抑郁情绪的研究

丁育钧 江玉文 蔡文玉 徐业传 吕晓伟

[摘要]目的探討县域医共体早期识别老年高血压患者焦虑抑郁情绪的方法。方法采用一般情况调查表、阿森斯失眠量表、中文版 MMAS-8量表和广泛焦虑问卷7项（GAD-7）、患者健康问卷9项（PHQ-9）、医院焦虑抑郁量表（HADS）对2019年6月至2021年3月在县域医共体门诊就诊的273例处于无临床并发症的病程早期的老年高血压患者进行问卷调查，对 HADS 总分≥9分者进行汉密尔顿焦虑量表（HAMA）及汉密尔顿抑郁量表（HAMD）联合评定。结果以焦虑抑郁情绪标准1：HADS 总分≥9分且 HAMA 评分≥14分和/或 HAMD 评分≥20分，检出焦虑抑郁情绪者108例，检出率为39.56%; logistic 回归分析显示女性、独居、文化程度低、月收入低、有临床症状、睡眠质量差和服药依从性低是焦虑抑郁情绪的危险因素，OR 值分别为2.465、2.539、1.923、1.838、2.193、1.961和2.242（P 值分别为0.002、0.008、0.002、0.007、0.008、0.018、0.007）;诊断指标“危险因素个数”和“危险因素累积 OR 值”的 ROC 曲线下面积分别为0.792和0.788，当危险因素个数为2.500和危险因素累积 OR 值为6.020时，诊断的敏感度与特异度之和最大，分别为1.660（0.963+0.697）和1.644（0.935+0.709）。以焦虑抑郁情绪标准2：危险因素≥3个且 GAD –7≥5分和/或 PHQ –9≥5分，检出焦虑抑郁情绪者114例，检出率为41.76%，与标准1比较，差异无统计学意义（P >0.05）。结论通过详细询问病史调查患者焦虑抑郁情绪的危险因素，对危险因素≥3个者进行 GAD –7和 PHQ –9问卷调查，可作为县域医共体早期识别老年高血压患者焦虑抑郁情绪的方法。

[关键词]高血压;老年;焦虑;抑郁

[中图分类号] R544.1  [文献标识码] A   [文章编号]2095-0616（2021）24-0038-05

A study of early identification of anxiety and depression of elderly patients with hypertension by county medical community

DING  Yujun    JIANG  Yuwen    CAI  Wenyu    XU  Yechuan    LV  Xiaowei

Department ofCardiovascular Medicine， Jinjiang Municipal Hospital ofFujian Province， Fujian， Jinjiang 362200， China

[Abstract] Objective To explore the method of early identification of anxiety and depression of elderly patients with hypertension by county medical community. Methods A questionnaire survey was conducted among a total of 273 elderly patients with hypertension in the early stage of the disease without clinical complications who received outpatient treatment in county medical community from June 2019 to March 2021 through general questionnaire， Athens Insomnia Scale， the Chinese version of MMAS-8 scale and Generalized Anxiety Disorder-7（GAD-7）， Patient Health Questionnaire-9（PHQ-9） and Hospital Anxiety and Depression Scale （HADS）. Those of the patients with total HADS score ≥9 were jointly assessed by Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD）. Results Under Criteria 1 of anxiety and depression， total HADS score ≥9 and HAMA score ≥14 and/or HAMD score ≥20， 108 cases of anxiety and depression were detected， and the detection rate was 39.56%. According to logistic regression analysis， the risk factors of anxiety and depression included being female， living alone， low education level， low monthly income， clinical symptoms， poor sleep quality and low medication compliance， with OR values of 2.465， 2.539， 1.923， 1.838， 2.193， 1.961 and 2.242 respectively （with the P values being 0.002， 0.008， 0.002， 0.007， 0.008， 0.018 and 0.007 respectively）. The area under the ROC curve of the diagnosis indices "number of risk factors" and "cumulative OR value of risk factors" was respectively 0.792 and 0.788. When the number of risk factors was 2.500 and the cumulative OR value of risk factors was 6.020， the sum of diagnostic sensitivity and specificity reached the maximum， which was respectively 1.660（0.963+0.697） and 1.644（0.935+0.709）. Under Criteria 2 of anxiety and depression， risk factors ≥3 and GAD-7≥5 points and/or PHQ –9≥5 scores， 114 cases of anxiety and depression were detected， and the detection rate was 41.76%， with no statistically significant differences when compared with those under Criteria 1（P >0.05）. Conclusion Collecting the risk factors of anxiety and depression by inquiring the medical history in detail and conducting questionnaire survey of those with risk factors ≥3 through GAD-7and PHQ-9 can be a method for county medical community to achieve early identification of anxiety and depression of elderly patients with hypertension.

[Key words] Hypertension; Elderly; Anxiety; Depression

高血压和焦虑抑郁情绪在老年人群中普遍存在[1]，焦虑抑郁情绪会进一步增高老年高血压患者发生心脑血管事件的风险[2]。基层……