孤独感在社区老年慢性病患者述情障碍和抑郁间的中介效应研究

doi:10.12114/j.issn.1007-9572.2021.02.082

摘要/Abstract

摘要： 背景　抑郁和孤独感是老年慢性病患者普遍存在的严重心理问题，述情障碍患者因“情感表达不能”可能会加剧负性心理体验，但其关联机制尚不明确。目的　探讨孤独感在社区老年慢性病患者述情障碍和抑郁间的中介效应。方法　2020年6—8月采用便利抽样法选取合肥市4个社区（望湖城社区、逍遥津社区、三孝口社区、亳州路社区）的509例社区老年慢性病患者为研究对象。采用一般资料调查表、多伦多述情障碍量表（TAS-26，评估述情障碍或情感表达困难）、UCLA孤独感量表（评估对社会交往的渴望与实际水平的差距而产生的孤独感）、中文版患者健康问卷抑郁自评量表（中文版PHQ-9，评估过去２周内抑郁症状的严重程度）进行问卷调查。根据TAS-26得分将患者分为高述情障碍组（TAS-26得分≥平均分）、低述情障碍组（TAS-26得分<平均分）。采用IBM SPSS 19.0和Amos 23.0软件进行数据分析。结果　共回收问卷509份，回收有效问卷492份，有效回收率为96.7%。社区老年慢性病患者中文版PHQ-9得分≥10分的有59例，抑郁症状发生率为12.0%（59/492）。社区老年慢性病患者TAS-26、UCLA孤独感量表、中文版PHQ-9得分分别为（71.8±8.3）、（36.6±8.5）、（6.0±3.2）分，Pearson相关分析结果显示，TAS-26与UCLA孤独感量表得分、中文版PHQ-9得分呈正相关（P<0.01）；UCLA孤独感量表得分与中文版PHQ-9得分呈正相关（P<0.01）。社区老年慢性病患者TAS-26得分的平均值为71.82分，TAS-26得分≥71.82分的患者共243例（高述情障碍组），TAS-26得分<71.82分的患者共259例（低述情障碍组）。高述情障碍组患者UCLA孤独感量表、中文版PHQ-9得分均高于低述情障碍组（P<0.05）。中介效应检验结果显示，社区老年慢性病患者述情障碍对抑郁有正向影响（β=0.25，P<0.01），述情障碍对孤独感有正向影响（β=0.68，P<0.01），孤独感对抑郁有正向影响（β=0.17，P<0.01）。孤独感在述情障碍和抑郁间的标准化间接效应为0.12，述情障碍对抑郁的标准化直接效应为0.25，中介效应占总效应的32.43%。结论　述情障碍能加重社区老年慢性病患者的孤独感和抑郁水平，且孤独感在述情障碍和抑郁间起部分中介作用。因此，社区管理者应早期识别老年慢性病患者的孤独感情绪，积极处理述情障碍对孤独的影响，从而降低其抑郁水平。

关键词: 慢性病, 老年人, 情感症状, 述情障碍, 孤独, 抑郁, 中介作用

Abstract: Background　Older chronic disease patients are mostly prone to depression and loneliness，two serious psychological problems，among whom those with alexithymia may suffer more due to the inability to express emotions. However，the mechanism of association of loneliness with alexithymia and depression is still unknown. Objective　To explore the mediating effect of loneliness on the association between alexithymia and depression in elderly chronic disease patients in the community. Methods　We performed a cross-sectional survey in Hefei，China，from June to August 2020. A total of 509 elderly patients with chronic diseases from 4 communities （Wanghucheng Community，Xiaoyaojin Community，Sanxiaokou Community，and Bozhou Road Community） in Hefei were selected using convenient sampling，then they were invited to attend a questionnaire survey using the General Demographic Questionnaire，26-item Toronto Alexithymia Scale （TAS-26），University of California，Los Angles Loneliness Scale（UCLALS），and Chinese version of Patient Health Questionnaire （PHQ-9） for collecting information including demographics，prevalence of alexithymia or having trouble identifying and describing emotions，subjective feelings of loneliness as well as feelings of social isolation，and prevalence of depression in the past two weeks. UCLALS and PHQ-9scores were compared by TAS-26 score. Data were analyzed by using IBM SPSS 19.0 and Amos 23.0. Results　The survey achieved a response rate of 96.7%（492/509）. Fifty-nine respondents with PHQ-9 score ≥10 were assessed with depression，accounting for 12% （59/492）. The scores of TAS-26，UCLALS and PHQ-9 of the respondents expressed as mean ± SD were （71.8±8.3），（36.6±8.5） and （6.0±3.2），respectively. Pearson correlation analysis showed that TAS-26 score was positively correlated with UCLALS score and PHQ-9 score （P<0.01）. And UCLALS score was positively correlated with PHQ-9 score（P<0.01）. High alexithymia respondents（n=243，TAS-26 score≥71.82） had higher average UCLALS score and PHQ-9 score than low alexithymia respondents（n=259，TAS-26 score<71.82）. Mediation analysis revealed that alexithymia had a positive effect on depression （β=0.25，P<0.01） and loneliness（β=0.68，P<0.01）. And loneliness had a positive effect on depression（β=0.17，P<0.01）. Moreover，the standardized indirect effect of loneliness on the association between alexithymia and depression was 0.12，the standardized direct effect of alexithymia on depression was 0.25，and the mediating effect accounted for 32.43% of the total effect. Conclusion　Alexithymia could strengthen the subjective feelings of loneliness and depression in elderly patients with chronic diseases in the community，and loneliness may play a partial mediating role between alexithymia and depression. To reduce the prevalence of depression，community managers should pay attention to identify loneliness，and actively deal with the impact of alexithymia on loneliness in this population.

Key words: Chronic disease, Aged, Affective symptoms, Alexithymia, Loneliness, Depression, Mediating effect

吴小婷,储爱琴,张海玲,等. 孤独感在社区老年慢性病患者述情障碍和抑郁间的中介效应研究[J]. 中国全科医学, 2021, 24(36): 4563-4568. DOI: 10.12114/j.issn.1007-9572.2021.02.082.

WU Xiaoting，CHU Aiqin，ZHANG Hailing，JIANG Yan. Mediating Effect of Loneliness between Alexithymia and Depression in Elderly Patients with Chronic Conditions in the Community　[J]. Chinese General Practice, 2021, 24(36): 4563-4568.

图/表 3

表1 社区老年慢性病患者TAS-26、UCLA孤独感量表、中文版PHQ-9得分的相关性分析（n=492，r值）

Table 1 Correlation analysis of scores of TAS-26，UCLA Loneliness Scale and Chinese version of PHQ-9 in elderly patients with chronic diseases in the community

量表	偏度值	峰度值	TAS-26	UCLA孤独感量表	中文版PHQ-9
TAS-26	0.235	0.377	1	-	-
UCLA孤独感量表	0.303	-0.542	0.467^a	1	-
中文版PHQ-9	0.425	0.512	0.269^a	0.333^a	1

表2 低述情障碍组和高述情障碍组患者UCLA孤独感量表、中文版PHQ-9得分及一般资料比较

Table 2 Comparison of UCLA Loneliness Scale and Chinese version of PHQ-9 scores as well as demographic data between community-living elderly chronic disease patients with low and high alexithymia

组别	例数	UCLA孤独感量表得分（分）	中文版PHQ-9得分（分）	年龄（岁）	性别〔n（%）〕
组别	例数	UCLA孤独感量表得分（分）	中文版PHQ-9得分（分）	年龄（岁）	男性	女性
低述情障碍组	249	33.6±7.3	5.4±2.9	70.9±7.1	114（45.8）	135（54.2）
高述情障碍组	243	39.6±8.5	6.6±3.3	71.7±7.6	103（42.4）	140（57.6）
χ²（t）值		-8.437^a	-4.157 ^a	-1.192 ^a	0.446
P值		<0.001	<0.001	0.234	0.504

图1 孤独感在社区老年慢性病患者述情障碍和抑郁间的中介作用模型

Figure 1 Mediation model of loneliness between alexithymia and depression in elderly chronic disease patients in the community

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