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浙江大学学报(医学版)  2020, Vol. 49 Issue (2): 203-208    DOI: 10.3785/j.issn.1008-9292.2020.03.02
原著     
2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析
李鑫1(),代甜2,王虹1,*(),石军年1,袁薇1,栗静1,陈利军1,张天明1,张珊珊1,孔焱1,岳宁1,时慧1,何玉苹1,胡惠芳1,柳芙蓉1,杨彩霞1
1. 兰州大学第二医院发热隔离病房, 甘肃 兰州 730030
2. 兰州大学公共卫生学院, 甘肃 兰州 730000
Clinical analysis of suspected COVID-19 patients with anxiety and depression
LI Xin1(),DAI Tian2,WANG Hong1,*(),SHI Junnian1,YUAN Wei1,LI Jing1,CHEN Lijun1,ZHANG Tianming1,ZHANG Shanshan1,KONG Yan1,YUE Ning1,SHI Hui1,HE Yuping1,HU Huifang1,LIU Furong1,YANG Caixia1
1. Fever Isolation Ward, Lanzhou University Second Hospital, Lanzhou 730030, China
2. School of Public Health, Lanzhou University, Lanzhou 730000, China
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摘要:

目的: 分析2019冠状病毒病(COVID-19)疑似患者伴发焦虑、抑郁的危险因素以便早期干预以改善临床预后。方法: 收集2020年1月31日至2月22日兰州大学第二医院发热隔离病房收治的COVID-19疑似患者76例,收集其临床资料并采用汉密尔顿焦虑量表评测患者焦虑情况,汉密尔顿抑郁量表评测患者抑郁情况,行多因素Logistic回归分析COVID-19疑似患者出现焦虑或抑郁的危险因素。结果: 女性患者较男性患者更易伴发焦虑(OR=3.206,95%CI:1.073~9.583,P < 0.05)和抑郁情绪(OR=9.111,95%CI:2.143~38.729,P < 0.01);患者存在已知疫区及疫区人员接触史更容易伴发抑郁情绪(OR=3.267,95%CI:1.082~9.597,P < 0.05)。结论: 在COVID-19疑似患者隔离治疗期间,对于存在已知疫区及疫区人员接触史的女性患者应该早期进行心理干预,必要时提早给予药物治疗,以改善患者预后。

关键词: 2019冠状病毒病严重急性呼吸综合征冠状病毒2新型冠状病毒肺炎焦虑抑郁Logistic模型    
Abstract:

Objective: To explore the risk factors of anxiety and depression in patients with suspected coronavirus disease 2019 (COVID-19) so as to achieve early intervention and better clinical prognosis. Methods: Seventy-six patients with suspected COVID-19 in fever isolation wards of Second Hospital of Lanzhou University were enrolled From January 31, 2020 to February 22, 2020. Their clinical baseline data were collected. The anxiety of patients was assessed by Hamilton Anxiety Scale, and the depression of patients was assessed by Hamilton Depression Scale. Multivariate Logistic regression analysis was performed to explore the risk factors of anxiety and depression in these patients. Results: Female patients are more likely to have anxiety (OR=3.206, 95%CI:1.073-9.583, P < 0.05) and depression (OR=9.111, 95%CI:2.143-38.729, P < 0.01) than male patients; patients with known contact history of epidemic area and personnel in epidemic area are more likely to have depression (OR=3.267, 95%CI:1.082-9.597, P < 0.05). Conclusion: During the isolation treatment of suspected COVID-19 patients, early psychological intervention should be carried out for the female patients with known contact history of epidemic area and personnel in epidemic area, and drug treatment should be given in advance if necessary.

Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Anxiety    Depression    Logistic models
收稿日期: 2020-02-27 出版日期: 2020-03-06
:  R749.2  
通讯作者: 王虹     E-mail: xin830910@163.com;1311098171@qq.com
作者简介: 李鑫(1983-), 男, 硕士, 副主任医师, 主要从事神经心理及脑血管病研究; E-mail:xin830910@163.com; https://orcid.org/0000-0001-7630-0163
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李鑫
代甜
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袁薇
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陈利军
张天明
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孔焱
岳宁
时慧
何玉苹
胡惠芳
柳芙蓉
杨彩霞

引用本文:

李鑫,代甜,王虹,石军年,袁薇,栗静,陈利军,张天明,张珊珊,孔焱,岳宁,时慧,何玉苹,胡惠芳,柳芙蓉,杨彩霞. 2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析[J]. 浙江大学学报(医学版), 2020, 49(2): 203-208.

LI Xin,DAI Tian,WANG Hong,SHI Junnian,YUAN Wei,LI Jing,CHEN Lijun,ZHANG Tianming,ZHANG Shanshan,KONG Yan,YUE Ning,SHI Hui,HE Yuping,HU Huifang,LIU Furong,YANG Caixia. Clinical analysis of suspected COVID-19 patients with anxiety and depression. J Zhejiang Univ (Med Sci), 2020, 49(2): 203-208.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.02        http://www.zjujournals.com/med/CN/Y2020/V49/I2/203

组 别 n 女 性 年龄(岁) 受教育程度
(本科及以上)
已 婚 已知疫区及疫区
人员接触史
已知外出旅行史或
聚众性场所活动史
既往确诊
精神疾病史
  “—”无相关数据.COVID-19:2019冠状病毒病.
伴发焦虑组 36 21(58.3) 38±18 16(44.4) 36(100.0) 8(22.2) 12(33.3) 4(11.1)
不伴发焦虑组 40 14(35.0) 34±12 21(52.5) 36(90.0) 7(17.5) 6(15.0) 4(10.0)
t/χ2 4.152 -0.959 0.492 2.059 0.267 3.523 0.000
P <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表 1  伴发焦虑与不伴发焦虑的COVID-19疑似患者一般情况比较
组 别 n 女 性 年龄(岁) 受教育程度
(本科及以上)
已 婚 已知疫区及疫区
人员接触史
已知外出旅行史或
聚众性场所活动史
既往确诊
精神疾病史
  “—”无相关数据.COVID-19:2019冠状病毒病.
伴发抑郁组 23 19(82.6) 38±16 10(43.5) 19(82.6) 10(43.5) 6(26.1) 3(13.0)
不伴发抑郁组 53 16(30.2) 35±15 37(69.8) 53(100.0) 5(9.4) 12(22.6) 5(9.4)
t/χ2 17.740 -0.874 0.358 6.554 9.684 0.105 0.004
P <0.01 >0.05 >0.05 <0.05 <0.01 >0.05 >0.05
表 2  伴发抑郁与不伴发抑郁的COVID-19疑似患者一般情况比较
变 量 β S.E. Wald P OR(95%CI)
  因婚姻状况中未婚者所占比例过小,且婚姻状况与年龄存在一定的共线性,遂未将婚姻状况纳入多因素Logistic回归分析.COVID-19:2019冠状病毒病.
女性 1.165 0.559 4.350 <0.05 3.206(1.073~9.583)
年龄 -0.005 0.020 0.055 >0.05 0.995(0.957~1.035)
受教育程度(本科及以上) -0.588 0.534 1.213 >0.05 0.556(0.195~1.581)
已知疫区及疫区人员接触史 0.315 0.810 0.151 >0.05 1.370(0.280~6.706)
已知外出旅行史或聚众性场所活动史 1.040 0.625 2.771 >0.05 2.829(0.832~9.623)
既往确诊精神疾病史 -0.778 0.922 0.712 >0.05 0.459(0.075~2.799)
表 3  COVID-19疑似患者伴发焦虑的多因素Logistic回归分析结果
变 量 β S.E. Wald P OR(95%CI)
  因婚姻状况中未婚者所占比例过小,且婚姻状况与年龄存在一定的共线性,遂未将婚姻状况纳入多因素Logistic回归分析.COVID-19:2019冠状病毒病.
女性 2.209 0.738 8.955 <0.01 9.111(2.143~38.729)
年龄 0.004 0.025 0.022 >0.05 1.004(0.956~1.054)
受教育程度(本科及以上) 0.233 0.721 0.104 >0.05 1.262(0.307~5.188)
已知疫区及疫区人员接触史 1.156 0.539 4.340 <0.05 3.267(1.082~9.597)
已知外出旅行史或聚众性场所活动史 0.739 0.764 0.934 >0.05 2.093(0.468~9.361)
既往确诊精神疾病史 -0.363 0.994 0.133 >0.05 0.695(0.099~4.883)
表 4  COVID-19疑似患者伴发抑郁的多因素Logistic回归分析结果
1 WANG C , HORBY P W , HAYDEN F G et al. A novel coronavirus outbreak of global health concern[J]. Lancet, 2020, 395 (10223): 470- 473
doi: 10.1016/S0140-6736(20)30185-9
2 PAULESC I , MARSTON H D , FAUCI A S . Coronavirus infection-more than just the common cold[J]. JAMA, 2020,
doi: 10.1001/jama.2020.075710
3 MUNSTER V J , KOOPMANS M , VAN DOREMALEN N et al. A novel coronavirus emerging in China-key questions for impact assessment[J]. N Engl J Med, 2020, 382 (8): 692- 694
doi: 10.1056/NEJMp2000929
4 CHAN J F , YUAN S , KOK K H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission:a study of a family cluster[J]. Lancet, 2020, 395 (10223): 514- 523
doi: 10.1016/S0140-6736(20)30154-9
5 杨蕴萍, 马征, 王传跃 . 重症急性呼吸综合征患者应激相关障碍及其心理干预的初步分析[J]. 中华精神科杂志, 2003, 36 (3): 183
YANG Yunping , MA Zheng , WANG Chuanyue . A preliminary analysis of stress-related disorders and psychological intervention in patients with severe acute respiratory syndrome[J]. Chinese Journal of Psychiatry, 2003, 36 (3): 183
doi: 10.3760/j:issn:1006-7884.2003.03.024
6 马征, 杜万君, 郭俊花 et al. 与重症急性呼吸综合征有关精神异常的临床观察[J]. 中华精神科杂志, 2004, 37 (2): 119- 120
MA Zheng , DU Wanjun , GUO Junhua et al. Clinical observation on severe acute respiratory syndrome associated mental disorders[J]. Chinese Journal of Psychiatry, 2004, 37 (2): 119- 120
doi: 10.3760/j:issn:1006-7884.2004.02.025
7 中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医涵[2020] 145号.(2020-02-18)[2020-02-28].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No.145[2020] of the General Office of the National Health Commission. (2020-02-18)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
8 张明园.精神科评定量表手册[M].长沙: 湖南科学技术出版社, 2003: 121-126.
ZHANG Mingyuan. Manual of psychiatric rating scale[M]. Changsha: Hunan Science & Technology Press, 2003: 121-126. (in Chinese)
9 HUANG C , WANG Y , LI X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395 (10223): 497- 506
doi: 10.1016/S0140-6736(20)30183-5
10 ZHU N , ZHANG D Y , WANG W L et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382 (8): 727- 733
doi: 10.1056/NEJMoa2001017
11 LI Q , GUAN X H , WU P et al. Early transmission dynamics in Wuhan, China, of novel coronavirus infected pneumonia[J]. N Engl J Med, 2020, 382 (13): 1199- 1207
doi: 10.1056/NEJMoa2001316
12 陈大明, 赵晓勤, 缪有刚 et al. 全球冠状病毒研究态势分析及其启示[J]. 中国临床医学, 2020, 27 (1): 1- 12
CHEN Daming , ZHAO Xiaoqin , MIAO Yougang et al. Analysis of the global coronavirus related research status and its enlightenment for the present and future[J]. Chinese Journal of Clinical Medicine, 2020, 27 (1): 1- 12
doi: 10.12025/j.issn.1008-6358.2020.20200199
13 SHELINE Y I , FREEDLAND K E , CARNEY R M . How safe are serotonin reuptake inhibitors for depression in patients with coronary heart disease?[J]. Am J Med, 1997, 102 (1): 54- 59
doi: 10.1016/s0002-9343(96)00374-9
14 敖明强, 潘扬, 马文琦 et al. 心脏科住院心房颤动患者焦虑抑郁情绪调查及其对生活质量的影响[J]. 东南大学学报(医学版), 2017, 36 (4): 637- 640
AO Mingqiang , PAN Yang , MA Wenqi et al. Investigation of anxiety and depression in hospitalized patients with atrial fibrillation and its impact on quality of life[J]. Journal of Southeast University (Medical Science Edition), 2017, 36 (4): 637- 640
doi: 10.3969/j.issn.1671-6264.2017.04.029
15 MAUNDER R , HUNTER J , VINCENT L et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital[J]. CMAJ, 2003, 168 (10): 1245- 1251
16 程刚, 肖友琴 . 社交焦虑障碍的性别差异及其生物学解释[J]. 中国健康心理学杂志, 2015, 23 (2): 307- 312
CHENG Gang , XIAO Youqin . Sex differences and biological reasons in social anxiety disorder[J]. China Journal of Health Psychology, 2015, 23 (2): 307- 312
doi: 10.13342/j.cnki.cjhp.2015.02.040
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