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

摘要

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 25 patients enrolled for each group from all these three departments , totally 150 patients were included .All the subjects completed seven self-as-sessment questionnaires including PHD-15, depression scale of the Patient Health Questionnaire (PHQ-9), Gener-alized 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 .%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（ de-pression 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。