【摘要】：背景老年抑郁癥的主要表現(xiàn)為情緒低落、焦慮、遲滯和軀體不適等,它不能簡(jiǎn)單歸同于軀體疾病和腦器質(zhì)性病變,近年發(fā)病率有不斷上升的趨勢(shì)。老年抑郁癥可導(dǎo)致老年人精神殘疾和自殺行為,給社會(huì)、家庭和個(gè)人帶來極大的負(fù)擔(dān)。國(guó)內(nèi)外已對(duì)老年抑郁癥做了大量的研究,但新疆針對(duì)維吾爾族老年抑郁癥的現(xiàn)狀研究較少。新疆60歲以上的老年人占10.93%,標(biāo)志著新疆已進(jìn)入老齡化社會(huì)。新疆老齡化具有農(nóng)村老齡化程度高于城鎮(zhèn),少數(shù)民族老齡人口數(shù)量高于漢族老齡人口,老年人口健康狀況較差的特點(diǎn)。維吾爾族老年人聚居地--和田曾經(jīng)是世界長(zhǎng)壽地區(qū)之一。維吾爾族老年人群的心身健康狀況如何值得關(guān)注。老年人較少會(huì)主動(dòng)咨詢心理醫(yī)生來解決貌似軀體疾病的心身問題,導(dǎo)致老年抑郁癥漏診現(xiàn)象嚴(yán)重。社區(qū)篩查可以使維吾爾族老年人的身心健康得到初步保障。目前尚無專門應(yīng)用維吾爾族語(yǔ)言篩查維吾爾族老年抑郁癥等精神狀況的評(píng)定量表,借鑒國(guó)內(nèi)外經(jīng)驗(yàn)開發(fā)一套維文版量表在維吾爾族老年人群中使用,對(duì)健康老齡化發(fā)展意義重大。老年抑郁癥病因復(fù)雜,它包含了社會(huì)、心理、免疫等多重作用的結(jié)果。對(duì)于社區(qū)首發(fā)維吾爾族老年抑郁癥的病例對(duì)照研究可以避免受醫(yī)院藥物和各種人為干擾因素的影響,較為客觀的探索各種社會(huì)影響因素及生化、免疫學(xué)指標(biāo)對(duì)該疾病的影響作用,為探討病因研究奠定基礎(chǔ)。目的(1)驗(yàn)證維文版GMS量表的使用效能,評(píng)價(jià)該量表的可行性、信度、效度等指標(biāo)。(2)在社區(qū)篩查維吾爾族老年抑郁癥,了解維吾爾族老年抑郁癥患病率及社會(huì)影響因素。(3)開展病例對(duì)照研究,比較軀體機(jī)能指標(biāo)和血脂、細(xì)胞因子在維吾爾族老年抑郁癥和正常對(duì)照組之間的差別,為老年抑郁癥的病因?qū)W研究奠定基礎(chǔ)。方法本課題包含三部分內(nèi)容：(1)第一部分：研究工具的選擇和應(yīng)用：運(yùn)用量表翻譯、回譯和文化調(diào)試方法翻譯GMS量表為維文版,在社區(qū)和醫(yī)院門診進(jìn)行維文版GMS量表信度和效度的考核。(2)第二部分：維吾爾族老年抑郁癥的現(xiàn)況調(diào)查：采取兩階段隨機(jī)分層抽樣在新疆維吾爾族人群較為集中的南疆、北疆和東疆各隨機(jī)抽取一個(gè)城市和農(nóng)村,再次隨機(jī)抽取該地區(qū)的社區(qū)或村,根據(jù)納入／排除標(biāo)準(zhǔn)在維吾爾族老年人群中運(yùn)用維文版GMS量表開展老年抑郁癥問卷調(diào)查,調(diào)查內(nèi)容還包含各種社會(huì)影響因素如：自評(píng)生活和健康的滿意現(xiàn)狀,社會(huì)支持現(xiàn)狀,自述軀體疾病的種類及數(shù)量,生活自理能力等方面。運(yùn)用logistic回歸模型對(duì)維吾爾族老年抑郁癥的相關(guān)社會(huì)影響因素進(jìn)行分析。(3)第三部分：維吾爾族老年抑郁癥病例對(duì)照研究：在前期現(xiàn)況調(diào)查的基礎(chǔ)上,經(jīng)精神科醫(yī)生根據(jù)CCMD-3診斷標(biāo)準(zhǔn)確診維吾爾族老年抑郁癥,隨機(jī)抽取病例54例,并在同樣地區(qū)進(jìn)行配對(duì)健康對(duì)照48例,測(cè)量體重、身高等軀體機(jī)能指標(biāo),檢測(cè)血脂系列、血清細(xì)胞因子IL-1β、IL、IL-6、TNF-α等指標(biāo)在病例與對(duì)照組之間的差異,明確這些指標(biāo)與維吾爾族老年抑郁癥的關(guān)系。結(jié)果(1)維文版GMS量表在新疆維吾爾族老年人中可行性較好,具有較好的信度和效度：維語(yǔ)版GMS量表的總Cronbach'a系數(shù)為0.963；評(píng)定者問一致系數(shù)為0.930；全量表的重測(cè)信度為0.870。專家內(nèi)容效度(CVI值)為0.856；以CCMD3醫(yī)生診斷為標(biāo)準(zhǔn)測(cè)定校標(biāo)效度,老年抑郁癥的診斷符合率為84.00%,靈敏度為85.42%(41/48),特異度為82.69%(43/52),陽(yáng)性預(yù)測(cè)值為82.00%(41/50),陰性預(yù)測(cè)值為86.00%(43/50),Kappa=0.68(P=0.00)。(2)本次調(diào)查城鄉(xiāng)社區(qū)維吾爾族老年抑郁癥患病率為10.60%,城市社區(qū)患病率為2.80%,農(nóng)村患病率為23.60%；男性患病率為5.91%,女性患病率為14.58%,女性是男性患病率的2.717倍(χ2=24.572,95%的可信區(qū)間：1.830-4.035)；(3)本次調(diào)查維吾爾族老年抑郁癥單因素分析顯示：維吾爾族老年抑郁癥的發(fā)生在婚姻狀況(χ2=1.853,P=0.603)、年齡(χ2=0.304,P=0.959)的差異無統(tǒng)計(jì)學(xué)意義,在文化程度(χ2=17.548,P=0.002)、職業(yè)(χ2=31.366,P=0.000)的差異有統(tǒng)計(jì)學(xué)意義；在吸煙(χ2=0.700,P=0.403)飲酒(χ2=0.082,P=0.775)的生活方式差異無統(tǒng)計(jì)學(xué)意義；維吾爾族老年抑郁癥的發(fā)生與是否參加集體旅游(x2=10.137,P=0.001)、是否參加社區(qū)活動(dòng)(χ2=11.087,P=0.001)、是否打牌(χ2=18.071,P=0.000)、是否打麻將(χ2=5.021,P=0.025)、是否下棋(χ2=6.349,P=0.011)、是否經(jīng)常散步(χ2=7.676,P=0.006)有相關(guān)性,其差異有統(tǒng)計(jì)學(xué)意義；社區(qū)維吾爾族老年抑郁癥患者在自評(píng)健康狀況中的差異有統(tǒng)計(jì)學(xué)意義(χ2=37.604,P=0.000)；患有一種以上軀體疾病的維族老年人所占比例占總?cè)藬?shù)的61.93%,3種以上軀體疾病人數(shù)占總?cè)藬?shù)的28.37%,患抑郁癥的比率高達(dá)22.02%；維吾爾族老年人日常生活能力損害率為3.83%；維吾爾族老年人與家人相處不融洽患抑郁癥的比率是相處融洽的2.184倍(χ2=4.840,95%的可信區(qū)間：1.089-4.382)；維族老年人負(fù)性生活事件數(shù)量中,3件以上發(fā)生抑郁癥的幾率是20.43%,負(fù)性生活事件中經(jīng)濟(jì)困難(χ2=13.559,95%的可信區(qū)間：1.449-3.518)和親人去世(χ2=10.695,95%的可信區(qū)間：1.289-2.828)的差異有統(tǒng)計(jì)學(xué)意義,發(fā)生經(jīng)濟(jì)困難引發(fā)老年抑郁癥的幾率是沒有經(jīng)濟(jì)困難老年人的2.258倍。日�；顒�(dòng)能力正常的老年人對(duì)抑郁癥的發(fā)生是一種保護(hù)因素,其OR值為0.217(χ2=14.709,95%的可信區(qū)間：0.099-0.474),經(jīng)檢驗(yàn)差異有統(tǒng)計(jì)學(xué)意義。(4)本次調(diào)查維吾爾族老年抑郁癥多因素logistic回歸分析顯示：老年抑郁癥的發(fā)生與女性、自評(píng)健康狀況差、有癡呆病史、患有中風(fēng)或部分癱瘓以及軀體疾病的數(shù)量、不同區(qū)域與維吾爾族老年抑郁癥有關(guān)聯(lián)；城鄉(xiāng)分層多因素Logistic回歸分析結(jié)果顯示：城市維吾爾族老年人自評(píng)健康狀況差,患有身體中風(fēng)和部分癱瘓,偏頭痛,參加宗教組織活動(dòng),負(fù)性生活事件等與維吾爾族老年抑郁癥有關(guān)聯(lián)；農(nóng)村維吾爾族老年人自評(píng)健康狀況差,女性,有抑郁癥病史、癡呆癥病史以及軀體疾病數(shù)量對(duì)老年抑郁癥有影響。自評(píng)健康狀況的好壞和軀體疾病數(shù)量與維吾爾族老年抑郁癥有關(guān)聯(lián)。(5)病例對(duì)照研究發(fā)現(xiàn)：病例組與對(duì)照組的收縮壓(t=2.697,P=0.008)、體重(t=2.153,P=-0.034)值差異有統(tǒng)計(jì)學(xué)意義,但兩組的時(shí)測(cè)收縮壓都在正常范圍之內(nèi)(對(duì)照組130.611±14.215,抑郁組137±8.693)；病例組甘油三脂高于對(duì)照組,經(jīng)檢驗(yàn)其差異有統(tǒng)計(jì)學(xué)意義t=2.084,P=-0.04,其余血脂指標(biāo)的差異均無統(tǒng)計(jì)學(xué)意義；病例組TNF-a指標(biāo)明顯高于對(duì)照組,經(jīng)檢驗(yàn)其差異有統(tǒng)計(jì)學(xué)意義(t=3.675,P=0.001),而IL-1β、IL-6、IL-2指標(biāo)與健康對(duì)照組相比較差異無統(tǒng)計(jì)學(xué)意義。結(jié)論(1)維文版GMS量表具有較好的信度及效度,診斷效能較好,可以在新疆社區(qū)維吾爾族老年人群中篩查老年抑郁癥。(2)維吾爾族老年抑郁癥患病率較高,與自評(píng)健康狀況差和軀體疾病數(shù)量較多有密切的關(guān)系,應(yīng)引起社會(huì)重視。城市老年抑郁癥患病率與內(nèi)地城市相當(dāng),但農(nóng)村老年抑郁癥患病率明顯高于內(nèi)地,與農(nóng)村維吾爾族老年人軀體疾病較多,自評(píng)健康狀況較差,女性社會(huì)地位較低,中風(fēng)或偏癱的病史有關(guān)。維吾爾族老年人忌煙限酒、大家庭聚居、與周圍鄰居相處融洽是其心身健康的保護(hù)因素,但較少參與傳統(tǒng)的智力游戲活動(dòng),自評(píng)經(jīng)濟(jì)困難,自評(píng)健康狀況差,軀體疾病數(shù)量增加,負(fù)性生活事件的增多對(duì)維吾爾族老年人心身健康有負(fù)面影響。(3)血壓、體重以及甘油三脂的升高進(jìn)一步增加了維吾爾族老年人患抑郁癥的風(fēng)險(xiǎn)。血清細(xì)胞因子TNF-a對(duì)維吾爾族老年抑郁癥有影響。鑒于本研究針對(duì)維吾爾人群,樣本來自社區(qū)人群且各種干擾因素較少,今后需進(jìn)一步增加病例對(duì)照研究的樣本量論證血清細(xì)胞因子在老年抑郁癥中的作用和相關(guān)性。
[Abstract]:Background depression is the main manifestation of depression, anxiety, retardation and physical discomfort. It can not be attributed to somatic disease and cerebral organic disease. In recent years, the incidence of senile depression has a rising trend. Senile depression can lead to mental disability and suicidal behavior of old people, and bring great burden to society, family and individual. A lot of research has been done on geriatric depression, but there is little research on the status quo of the Uygur depression in Xinjiang. The aged people over 60 years old in Xinjiang account for 10.93%, which indicates that Xinjiang has entered an aging society. The aging of Xinjiang has a higher degree of aging in rural areas than in cities and towns, and the number of old people in ethnic minorities is higher than that of the Han population. Old people are older than the Han people. The health status of the old people in Uygur people is one of the world longevity areas. The mental health of the elderly Uygur people is worth paying attention to. The elderly are less likely to consult the psychologist to solve the psychosomatic problems that appear to be similar to the body disease, which leads to the serious misdiagnosis of senile depression. Community screening can ensure the physical and mental health of the Uygur people. At present, there is no special application of Uygur language to screen the mental status of Uygur elderly depression. It is useful for the Uygur people to develop a set of Uygur version scale for reference, and it is of significance to the development of healthy aging. The cause of the elderly depression is complex, which includes the results of social, psychological, immune and other multiple effects. The case control study of the first Uygur depression in the community can avoid the influence of hospital drugs and all kinds of human interference factors, and more objectively explore various social factors and biochemistry, and the immunological index is the same. The impact of the disease to study the cause of the cause of the study. Objective (1) to verify the effectiveness of the version of the GMS scale, to evaluate the feasibility, reliability and validity of the scale. (2) in community screening of Uygur senile depression, the prevalence and social factors of Uygur depression and social influence factors. (3) a case control study was carried out. The difference between the body function index and the blood lipid, the cytokine in the Uygur depression and the normal control group is the basis for the etiological study of the senile depression. Methods this topic includes three parts: (1) the first part: the selection and application of the research tools: using scale translation, back translation and cultural debugging methods to translate G The MS scale is the version of the Uygur version and the assessment of the reliability and validity of the GMS scale in the community and hospital outpatients. (2) the second part: the current situation of the Uygur elderly depression: Taking the two stage random stratified sampling in the South Xinjiang, the North Xinjiang and the East Xinjiang, the city and the countryside of the north and East Xinjiang are randomly selected in Xinjiang. The community or village of the area was randomly selected. According to the inclusion / exclusion criteria, the Uygur version of the GMS scale was used to carry out a questionnaire survey on geriatric depression. The contents of the survey included various social factors, such as self evaluation of life and health, status of social support, the type and quantity of self described somatic disease. The logistic regression model was used to analyze the related social factors related to the Uygur depression. (3) the third part: a case control study of the Uygur depression: on the basis of the prophase status survey, the psychiatrists confirmed the Uygur depression according to the CCMD-3 diagnostic criteria. 54 cases were randomly selected and 48 cases were matched in the same area. The body weight, height and other body function indexes were measured, the blood lipid series, serum cytokine IL-1 beta, IL, IL-6, TNF- alpha were different between the cases and the control group, and the relationship between these indexes and the Uygur depression was clearly defined. Results (1) the GMS quantity of the Uygur version The table has good reliability and validity among the Uygur people in Xinjiang, which has good reliability and validity: the total Cronbach'a coefficient of the GMS scale of the Uygur version is 0.963; the consensus coefficient of the assessor is 0.930; the retest reliability of the total scale is 0.856 of the 0.870. expert content validity (CVI value); the calibration validity is determined by the standard of doctor CCMD3 and the old age is suppressed. The diagnostic coincidence rate of depression was 84%, the sensitivity was 85.42% (41/48), the specificity was 82.69% (43/52), the positive predictive value was 82% (41/50), the negative predictive value was 86% (43/50), Kappa=0.68 (P=0.00). (2) the prevalence rate of Uygur depression in urban and rural communities was 10.60%, the urban community prevalence rate was 2.80% and the rural prevalence rate was 23.60%. The male prevalence rate was 5.91%, the female prevalence rate was 14.58%, the female was 2.717 times the male prevalence rate (the X 2=24.572,95% confidence interval: 1.830-4.035); (3) the single factor analysis of Uygur senile depression showed that the occurrence of Uygur depression was in marital status (x 2=1.853, P=0.603), age (x 2=0.304, P=0.959). There was no statistically significant difference in the difference in educational level (chi 2=17.548, P=0.002), occupation (chi 2=31.366, P=0.000), and there was no significant difference in the lifestyle difference between smoking (chi 2=0.700, P=0.403) drinking (chi 2=0.082, P=0.775), and the occurrence of old age depression in Uygur and whether to participate in collective tourism (x2=10.137, P=0.001). Whether to participate in the community activities (chi 2=11.087, P=0.001), whether to play cards (chi 2=18.071, P=0.000), whether to play mahjong (chi 2=5.021, P=0.025), whether to go chess (chi 2=6.349, P=0.011), whether the frequent walk (chi 2=7.676, P=0.006) is relevant, the difference is statistically significant; community Uygur depression in the health of the elderly patients in the health status of the difference is Statistical significance (2=37.604, P=0.000); the proportion of elderly people with more than one kind of physical disease accounted for 61.93% of the total, 3 or more kinds of physical diseases accounted for 28.37% of the total, the rate of depression was up to 22.02%, and the rate of daily living impairment of the Uygur people was 3.83%. The ratio of depression to depression was 2.184 times as good as that of harmony (the confidence interval of X 2=4.840,95%: 1.089-4.382); in the number of negative life events in the elderly, the risk of depression was 20.43%, the economic difficulties in negative life events (the confidence interval of the X 2=13.559,95%: 1.449-3.518) and the death of relatives (x 2=10.695,9) 5% of the confidence interval: 1.289-2.828) was statistically significant, and the risk of economic difficulties was 2.258 times as high as that of the elderly without economic difficulties. The elderly with normal daily activity were a protective factor for depression, and the OR value was 0.217 (x 2=14.709,95% confidence interval: 0.099-0.474). (4) the multi factor Logistic regression analysis of the Uygur depression showed that the occurrence of senile depression and the female, the poor health status, the history of dementia, the number of stroke or partial paralysis and the body disease, the different regions were associated with the Uygur depression, and the urban and rural areas were divided. The results of multi factor Logistic regression analysis showed that the health status of urban Uygur elderly was poor, suffering from physical apoplexy and partial paralysis, migraine, participation in religious organization and negative life events were associated with Uygur depression, and the health status of Uygur people in rural areas was poor, women and depression. History, the history of dementia and the number of somatosensory diseases had an impact on depression. The quality of health and the number of physical diseases were associated with the Uygur depression. (5) case control studies found that the systolic pressure (t=2.697, P=0.008) and weight (t=2.153, P=-0.034) of the case group and the control group were statistically significant, but two The systolic pressure of the group was within the normal range (130.611 + 14.215 in the control group and 137 in the depression group, 137 + 8.693). The difference of glycerol and three fat in the case group was higher than that of the control group. The difference was statistically significant t=2.084, P=-0.04, and the other blood lipid indexes were not statistically significant; the TNF-a index in the case group was significantly higher than that of the control group. Statistical significance (t=3.675, P=0.001), and IL-1 beta, IL-6, IL-2 indicators compared with the health control group, there is no statistical difference. Conclusion (1) the vien version GMS scale has better reliability and validity, the diagnostic efficiency is better, can be screened for elderly depression in the Xinjiang community Uygur elderly people. (2) the prevalence rate of Uygur depression is more than that of Uygur. The prevalence rate of senile depression in urban areas is similar to that in mainland cities, but the prevalence rate of elderly depression in rural areas is significantly higher than that in the mainland, and there are more physical diseases in the rural Uygur elderly, poor health and low social status in women. The history of apoplexy or hemiplegia is related to the medical history of the elderly in Uygur. The old people of the Uygur people avoid smoking limited wine, the large family live together, and the harmony with their neighbors is the protective factor for their health. However, they are less involved in the traditional intellectual game activities, self evaluation of economic difficulties, poor health status, the increase of the number of physical diseases, and the increase of negative life events to the Uygur people. Human health has a negative impact. (3) blood pressure, weight and the increase of glycerin three fat further increase the risk of depression in the Uygur elderly. Serum cytokine TNF-a has an impact on Uygur elderly depression. One step is to increase the sample size of case-control study to demonstrate the role and correlation of serum cytokines in senile depression.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2013
【分類號(hào)】：R749.4

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