本文選題：慢性疼痛 + 抑郁�。� 參考：《山西醫(yī)科大學(xué)》2013年碩士論文

【摘要】：研究目的 通過分析慢性疼痛與災(zāi)難化認知、社會支持、依戀、抑郁之間的關(guān)系,構(gòu)建慢性疼痛抑郁依戀模型,豐富國內(nèi)有關(guān)慢性疼痛患者抑郁易感性機制的理論研究,為臨床及早發(fā)現(xiàn)慢性疼痛合并抑郁患者及其康復(fù)提供心理學(xué)依據(jù)。 研究方法 本研究采用方便抽樣法。調(diào)查對象為2012年9月至2013年1月重慶市西南醫(yī)院類風(fēng)濕關(guān)節(jié)炎310例住院患者。使用簡化McGill疼痛問卷、SDS抑郁自評量表、中譯版疼痛災(zāi)難化量表、社會支持評定量表和親密關(guān)系體驗問卷進行調(diào)查研究。 研究結(jié)果 (1)疼痛狀況：患者的疼痛年限以0-9年居多(64.21%)；多為慢性間斷疼痛(69.57%)；感受到的疼痛強度多為重度疼痛(30.11%)；現(xiàn)時疼痛強度以疼痛不適(46.49%)為主。 (2)慢性疼痛患者合并抑郁情況：抑郁發(fā)生率為32.00%；無抑郁患者68.00%,輕微至輕度抑郁患者15.66%,中度至重度抑郁患者11.67%,重度抑郁患者4.67%。不同性別患者(p=0.226)、不同文化程度患者(p=0.225)抑郁程度并無顯著差異；不同年齡階段(p=0.041)、不同婚姻狀況患者(p=0.007)、不同職業(yè)患者(p=0.001)、不同居住地患者(p=0.000)、不同醫(yī)療保險種類的患者(p=0.000)和不同家庭經(jīng)濟收入狀況的患者(p=0.000)抑郁程度有顯著性差異。 (3)依戀狀況比較：依戀回避維度上顯示,性別(p=0.014)和抑郁程度(p=0.000)不同的患者依戀回避具有顯著性差異,不同年齡階段患者(p=0.610)依戀回避不具有統(tǒng)計學(xué)意義；依戀焦慮維度上顯示,不同性別(p=0.013)、不同年齡階段(p=0.006)、不同抑郁程度(p=0.000)的患者在依戀焦慮上都有顯著性差異。 (4)相關(guān)分析顯示：慢性疼痛各維度與抑郁呈顯著正相關(guān)(0.41,0.30,0.45,0.32)；依戀回避與慢性疼痛各維度呈正相關(guān)(0.15,0.03,0.17,0.04),依戀焦慮與慢性疼痛各維度呈正相關(guān)(0.22,0.11,0.19,0.25)；抑郁和依戀回避、依戀焦慮均呈顯著正相關(guān)(0.34,0.41)。 (5)調(diào)節(jié)效應(yīng)分析顯示：依戀在慢性疼痛與抑郁的關(guān)系中起著調(diào)節(jié)作用(F=18.109,p=0.000)；依戀在疼痛災(zāi)難化與抑郁的關(guān)系中起著調(diào)節(jié)作用(F=27.658,p=0.000)；依戀在社會支持與抑郁的關(guān)系中起著調(diào)節(jié)作用(F=12.042,p=0.000)。 (6)慢性疼痛抑郁依戀模型分析顯示：慢性疼痛以疼痛災(zāi)難化、社會支持和依戀為中介對抑郁的預(yù)測模型符合假設(shè)模型,模型擬合指標χ2/df=2.873,RMSEA=0.079, GFI=0.927, NFI=0.900, CFI=0.931。慢性疼痛對抑郁有四條作用路徑：慢性疼痛→災(zāi)難化→抑郁,慢性疼痛→依戀→抑郁,慢性疼痛→依戀→災(zāi)難化→抑郁,慢性疼痛→依戀→社會支持→抑郁。 研究結(jié)論 (1)患者的疼痛年限一般較長,多以間斷性疼痛為主,患者感受到的疼痛強度各種程度都有,住院患者現(xiàn)時疼痛強度一般較低。 (2)慢性疼痛患者合并抑郁發(fā)生率較高,不同經(jīng)濟狀況、疼痛強度、依戀特征的患者其抑郁有差異。 (3)依戀分別對疼痛強度、疼痛災(zāi)難化和社會支持與抑郁的關(guān)系具有調(diào)節(jié)作用。 (4)慢性疼痛是預(yù)測患者抑郁的一個重要因素,通過災(zāi)難化與依戀間接作用于抑郁；慢性疼痛以依戀、疼痛災(zāi)難化為中介對抑郁具有間接作用；慢性疼痛以依戀、社會支持為中介對抑郁具有間接作用。
[Abstract]:research objective
Through the analysis of the relationship between chronic pain and disastrous cognition, social support, attachment, and depression, the model of chronic pain and depression is constructed, and the theoretical research on the mechanism of depression and susceptibility to chronic pain in China is enriched to provide psychological basis for the early detection of chronic pain and depression in patients and their rehabilitation.
research method
A convenient sampling method was used in this study. The subjects were 310 patients with rheumatoid arthritis in Southwest Hospital of Chongqing from September 2012 to January 2013. The simplified McGill pain questionnaire, SDS depression self rating scale, the Chinese version of the Chinese version of the pain catastrophe scale, the social support rating scale and the intimate customs experience questionnaire were investigated.
Research results
(1) pain status: the patient's pain years are more than 0-9 years (64.21%); most of them are chronic discontinuous pain (69.57%); the pain intensity is more severe (30.11%), and the current pain intensity is mainly with pain discomfort (46.49%).
(2) the incidence of depression in patients with chronic pain was 32%, 68% without depression, 15.66% in mild to mild depression, 11.67% in moderate to severe depression, and for 4.67%. with different sex (p=0.226) in severe depressive patients (p=0.226), and there was no significant difference in the degree of depression in patients with different educational levels (P =0.225); p=0 .041), different marital status patients (p=0.007), different occupational patients (p=0.001), different residence patients (p=0.000), patients with different kinds of medical insurance (p=0.000) and patients with different family economic income (p=0.000) have significant difference in depression degree.
(3) comparison of attachment status: the attachment avoidance dimension showed that there were significant differences in attachment avoidance in patients with different sex (p=0.014) and depression degree (p=0.000). The attachment avoidance in different age groups (p=0.610) was not statistically significant; the attachment anxiety dimension showed that different sex (p=0.013), different age stage (p=0.006), different inhibition. Yu Chengdu (p=0.000) patients have significant differences in attachment anxiety.
(4) the correlation analysis showed that there was a significant positive correlation between all dimensions of chronic pain and depression (0.41,0.30,0.45,0.32); attachment avoidance was positively correlated with all dimensions of chronic pain (0.15,0.03,0.17,0.04); attachment anxiety was positively correlated with all dimensions of chronic pain (0.22,0.11,0.19,0.25); depression and attachment avoidance, and attachment anxiety were positively correlated (0.34, 0.41).
(5) the analysis of regulatory effect shows that attachment plays a regulatory role in the relationship between chronic pain and depression (F=18.109, p=0.000); attachment plays a regulatory role in the relationship between pain and depression (F=27.658, p=0.000), and attachment plays a regulatory role in the relationship between social support and depression (F=12.042, p=0.000).
(6) the analysis of chronic pain and depressive attachment model showed that chronic pain was disastrous with pain, and social support and attachment as the mediator conformed to the hypothetical model of depression. The model fitting index Chi 2/df=2.873, RMSEA=0.079, GFI=0.927, NFI=0.900, CFI=0.931. had four ways of chronic pain to depression: chronic pain - disastrous Depression, chronic pain, attachment, depression, chronic pain, attachment, disastrous depression, chronic pain, attachment, social support, depression.
research conclusion
(1) the patient's pain years are generally long, mostly with intermittent pain. The pain intensity of the patients is all in all degrees, and the pain intensity of the hospitalized patients is generally low.
(2) the incidence of depression in patients with chronic pain is relatively high. There are differences in depression among patients with different economic conditions, pain intensity and attachment characteristics.
(3) attachment has a moderating effect on the relationship between pain intensity, disastrous pain, and social support and depression.
(4) chronic pain is an important factor in predicting depression in patients, which indirectly affects depression through disastrous and attachment; chronic pain is dependent on attachment and pain disastrous as a mediator for depression; chronic pain is dependent on attachment, and social support is the intermediary for depression.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.41

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