慢性耳鸣患者合并焦虑和抑郁影响因素的分析

Influencing Factors of Anxiety and Depression in Patients with Chronic Tinnitus

宋勇莉;齐柳;陈阳;查定军;

1:中国人民解放军空军军医大学第一附属医院耳鼻咽喉头颈外科

摘要
目的探讨慢性耳鸣患者中焦虑和抑郁的伴发情况及其影响因素。方法以2018年1月到2019年11月就诊于空军军医大学第一附属医院耳鼻喉科门诊并诊断为慢性耳鸣的278例患者为研究对象,所有患者均进行详细的病史询问和评估,接受纯音测听、耳鸣心理声学检测,填写耳鸣病史调查表、耳鸣残疾量表(tinnitus handicap inventory, THI)、焦虑自评量表(self-rating anxiety scale, SAS)、抑郁自评量表(self-rating depression scale, SDS)、匹兹堡睡眠质量指数量表(Pittsburgh sleep scale, PSQI)和D型人格量表(type D personality scale-14, DS-14),分析慢性耳鸣患者中焦虑和抑郁的发生情况及可能的影响因素。结果 278例慢性耳鸣患者,平均SAS评分为43.66±8.71分,平均SDS评分为45.38±9.96分,均高于正常常模得分(30分);其中合并焦虑73例(26.26%),合并抑郁91例(32.73%),同时合并焦虑及抑郁51例(18.35%)。Logistic回归分结果显示,性别(男性OR=0.29)、THI评分(OR=1.03)、PSQI评分(OR=1.31)及D型人格(OR=5.34)与焦虑相关,而THI评分(OR=1.03)、PSQI评分(OR=1.32)及D型人格(OR=4.75)与抑郁相关。结论焦虑和抑郁是慢性耳鸣患者常见的合并心理障碍,而耳鸣的严重程度、睡眠障碍及D型人格是其危险因素,其中以D型人格最为突出,在慢性耳鸣合并焦虑或抑郁患者的诊治过程中应予以关注。
关键词
慢性耳鸣;焦虑;抑郁;D型人格;睡眠障碍
基金项目(Foundation):
作者
宋勇莉;齐柳;陈阳;查定军;
参考文献

[1] Pattyn T,Van Den Eede F,Vanneste S,et al.Tinnitus and anxiety disorders:a review[J].Hear Res,2016,333:255-265.

[2] Trevis KJ,McLachlan NM,Wilson SJ.Psychological mediators of chronic tinnitus:the critical role of depression[J].JAffect Disord.,2016,204:234-240.

[3] Bhatt JM,Bhattacharyya N,Lin HW.Relationships between tinnitus and the prevalence of anxiety and depression[J].Laryngoscope,2017,127(2):466-469.

[4] Trevis KJ,McLachlan NM,Wilson SJ.A systematic review and meta-analysis ofpsychological functioning in chronic tinnitus[J].ClinPsychol Rev,2018,60:62-86.

[5] Hébert S,Canlon B,Hasson D,et al.Tinnitus severity is reduced with reduction of depressive mood-aprospective population study in Sweden[J].PLoS One,2012,7(5):e37733.

[6]辛颖,陶立元,王洁,等.耳鸣残疾问卷中文版的信度和效度检验及临床应用[J].听力学及言语疾病杂志,2015,23(5):457-461.

[7]王征宇,迟玉芬.焦虑自评量表(SAS)[J].上海精神医学杂志,1984(2):73-74.

[8]王征宇,迟玉芬.抑郁自评量表(SDS)[J].上海精神医学杂志,1984(2):71-72.

[9]陆林,王雪芹,唐向东.睡眠与睡眠障碍相关量表[M].北京:人民卫生出版社,2016.219-221.

[10] Denollet J.DS14:standard assessment of negative affectivity,social inhibition,and Type D personality[J].Psychosomatic Medicine,2005,67(1):89-97.

[11] Tunkel DE,Bauer CA,Sun GH,et al.Clinical practice guideline:tinnitus[J].Otolaryngol Head Neck Surg,2014,151(2Suppl):S1-540.

[12]中华耳鼻咽喉头颈外科杂志编辑委员会耳科专业组,2012耳鸣专家共识及解读[J].中华耳鼻咽喉头颈外科杂志,2012,47(9):709-712.

[13] McKenna L,Handscomb L,Hoare DJ,et al.A scientific cognitive-behavioral model of tinnitus:novel conceptualizations of tinnitus distress[J].Front Neurol,2014,5:196.

[14]宋凡,陈秀兰,王斌.急、慢性耳鸣的临床和心理声学特征分析[J].中华耳科学杂志,2017,15(1):71-76.

[15]李尧,王铭歆,周婧,等.特发性耳鸣患者的焦虑和抑郁状态的研究及相关因素分析[J].临床耳鼻咽喉头颈外科杂志,2019,33(5):416-421.

[16] Asher M,Asnaani A,Aderka IM.Gender differences in social anxiety disorder:a review[J].Clin Psychol Rev,2017,56:1-12.

[17]贾若,孙凤新,刘博.耳鸣和情绪认知的相关性研究[J].中华耳科学杂志,2016,14(2):158-162.

[18] Kim JS.Association between tinnitus and mental health among Korean adolescents:the Korea National Health and Nutrition Examination Survey[J].Cent Eur J Public Health,2018,26(1):65-70.

[19]贾若,刘博,成雷,等.耳鸣患者睡眠质量的临床分析[J].临床耳鼻咽喉头颈外科杂志,2019,33(10):961-965.

[20] Xie L,Kang H,Xu Q,et al.Sleep drives metabolite clearance from the adult brain[J].Science,2013,342(6156):373-377.

[21] Mendelsohn AR,Larrick JW.Sleep facilitates clearance of metabolites from the brain:glymphatic function in aging and neurodegenerative diseases[J].Rejuvenation Res,2013,16(6):518-523.

[22]Iliff JJ,Wang M,Liao Y,et al.A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes,including amyloidβ[J].Sci Transl Med,2012,4(147):147ra111.

[23]余力生,马鑫.耳鸣的代偿与失代偿[J].中华耳鼻咽喉头颈外科杂志,2017,52(8):630-633.

[24] Condén E,Ekselius L,Aslund C.Type D personality is associated with sleep problems in adolescents.Results from a population-based cohort study of Swedish adolescents[J].J Psychosom Res,2013,74(4):290-295.

[25] Kupper N,Denollet J.Type D personality is associated with social anxiety in the general population[J].Int J Behav Med,2014,21(3):496-505.

[26] Bartels H,Middel B,Pedersen SS,et al.The distressed(type D)personality is independently associated with tinnitus:a case-control study[J].Psychosomatics,2010,51(1):29-38.

[27] Bartels H,Pedersen SS,van der Laan BF,et al.The impact of type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression[J].Otol Neurotol,2010,31(1):11-18.

[28] Choi YS,Na HG,Song SY,et al.The analysis of anxiety,depression,and type D personality in patients with tinnitus[J].Korean J Otorhinolaryngol-Head Neck Surg,2014,57(1):22-26.

[29]孟昭兰.情绪心理学[M].北京:北京大学出版社,2005.4-15.

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