北京协和医院门诊多躯体症状患者的疾病归因特点

摘要

Objective To explore the characteristics of illness attribution of outpatients with multiple somatic symptoms in Peking Union Medical College Hospital. Methods It was a cross-sectional study conducted from March to October,2012. A total of 150 outpatients were recruited from the departments of Gastroenterology,Traditional Chinese Medicine and Psychological Medicine by convenience sampling. Somatic symptom scale of the Patient Health Questionnaire (PHQ-15) was used to screening each patient in the waiting list. With the cut-off value of 10,patients were divided into the somatic symptom positive (SOM+) group and somatic symptom negative (SOM-) group. Sociodemographic characteristics were compared between these two groups. All the subjects completed interviews including questions about illness attribution. All the answers of illness attribution were concluded into three major groups as physical factors,situational factors and psychological factors. Results The proportion of female was significantly higher in SOM+ group than in SOM-group (69.3% vs. 53.3%;χ2=4.048,P=0.044). In SOM+ group,significantly more patients contributed their illness to psychological factors (64.0% vs. 45.0%;χ2=5.273,P=0.022). There was no significantly difference between SOM+ group and SOM-group on the phenomenon of multiple illness attribution (41.0% vs. 32.0%;χ2=1.407,P=0.236). However,in the Department of Gastroenterology,there were significantly more outpatients in SOM+ group with multiple illness attribution (60.0% vs. 32.0%;χ2=3.945,P=0.047).Conclusions The outpatients in general hospital with multiple somatic symptoms are more likely to contribute their illness to psychological factors. The phenomenon of multiple illness attribution is common among patients. Clinicians should increase their awareness and knowledge of illness attribution,so as to provide better holistic health services.%目的 初步了解北京协和医院门诊多躯体症状患者的疾病归因特点.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患者通过躯体症状严重程度量表(PHQ-15)进行连续筛查.依据PHQ-15≥10分或<10分将患者分为多躯体症状组(SOM+组)和对照组(SOM-组),每科每组均纳入25例患者,共纳入150例患者.所纳入患者均完成人口学资料收集及疾病归因的访谈问卷.将患者的疾病归因内容归纳为体(素)质因素、环境因素和心理因素3类.结果 SOM+组女性所占比例明显高于SOM-组(69.3%比53.3%;χ2=4.048,P=0.044).SOM+组对症状进行心理归因者所占的比例明显高于SOM-组(64.0%比45.0%;χ2=5.273,P=0.022),其中消化内科患者两组间差异更为明显(64.0%比20.0%;χ2=9.934,P=0.002).SOM+组中将疾病归因于两个或更多因素的患者所占比例(41.0%)高于SOM-组(32.0%),但差异无统计学意义(χ2=1.407,P=0.236);在消化内科访谈对象中,两者差异有统计学意义(60.0%比32.0%;χ2=3.945,P=0.047).结论 在北京协和医院门诊中,具有多个躯体症状的患者比躯体症状相对单一的患者更常将疾病归因于心理因素;患者将疾病归因至两个或更多因素的现象在各科患者中普遍存在.临床医生在诊疗中从多个角度探索和理解患者的疾病归因,将有助于患者获得更好的整体医学服务.