癌症住院病患憂鬱狀態的盛行率及預測因素

The Prevalence and Predictors of Depression in Cancer Inpatients

本研究採橫斷式描述性相關設計，共收集96位癌症住院病患的資料進行分析，研究目的在於：（1）了解臺灣癌症住院病患憂鬱的樣本盛行率，及（2）檢測疾病及人口學相關變項預測憂鬱發生的能力。研究中對憂鬱個案的界定為精神科醫師以迷你國際神經精神醫學面談問卷輔以DSM-Ⅳ診斷準則進行結構式會談所得到的診斷結果中之重鬱症、輕鬱症、憂鬱型適應性疾患及混合型適應性疾患的病患。研究結果顯示研究對象的憂鬱盛行率為33.3%。單因子邏輯迴歸分析發現憂鬱的發生分別和病患的身體功能狀態、自覺疾病治療效果、教育程度及家庭經濟狀況有關。進一步以多因子邏輯迴歸之前向條件法進行分析，發現癌症住院病患憂鬱的最佳預測模式包括身體功能狀態、家庭經濟狀況及自覺疾病治療效果三項預測因子，而使用此模式來預測癌症住院病患憂鬱的發生之準確性為77%；其中身體功能狀態較差、家庭經濟狀況較差及自覺疾病治療無效者罹患憂鬱的機率較高。結果中也發現疼痛的有無與憂鬱的發生並沒有相關，但進一步對有疼痛的樣本進行分析，發現疼痛型態與憂鬱有關。對於50位有疼痛的癌症住院病患而言，包括自覺疾病治療效果、疼痛型態及身體功能狀態三個預測因子的迴歸模式，其預測憂鬱發生之正確性達88%。由以上結果可知癌症住院病患有相當高的憂鬱盛行率；而身體功能狀態較差、自覺疾病治療無效、教育程度較低、家庭經濟狀況較差及持續性疼痛為癌症住院病患發生憂鬱疾患的危險因素。因此臨床上對於這些危險因子必須要仔細地評估，並對憂鬱的高危險群提供更多的身體及心理社會的支持。

Depression is a common problem for cancer patients. The purposes of this study were (a) to examine the prevalence of depression in Taiwanese cancer inpatients, and (b) to identify medical and demographic variables on prediction of depression. A total of 96 Taiwanese cancer inpatients were recruited in this study. Four instruments were used to collect data: the Demographic Data Form, the Karnofsky Performance Scale, the Pain Assessment Form, and the Mini-International Neuropsychiatric Interview (M.I.N.I.) Schedule. Definition of depression in this study included the psychiatric diagnoses of major depressive disorder, dysthymic disorder, and adjustment disorders with depressed mood or mixed emotional features. The prevalence of depression in this study is 33.3%. Results of univariate logistic regression indicated that depression was related to physical functional status, perceived treatment effect, educational level, and family income. Conditional forward method of multivariate logistic regression revealed that the best subset to predict the depression included functional status, family income, and perceived treatment effect. Using the above three variables, the precision was 77% for predicting the occurrence of depression. The likelihood of being diagnosed as depression was found to increase among subjects with poor functional status, lower family income, and perception of treatment ineffectiveness. For the sub-sample with pain, the best predicting variables for depression were perceived treatment effect, pain pattern, and functional status, with the overall correct rate of 88%. The results of this study confirm that the prevalence of depression in cancer inpatients is high. Poor functional status, perception of treatment ineffectiveness, lower educational level, lower family income, and consistent pain pattern are risk factors of depression. The results indicate that clinical evaluation of risk factors of depression in cancer inpatient is necessary. Nurses should offer more physical and psychosocial support for high-risk patients.