心理社會危險因子與心血管疾病

Psychosocial Risk Factors and Cardiac Rehabilitation

翁嘉英(Chia-Ying Weng) ； 林庭光(Tin-Kwang Lin) ； 陳志暐(Chih-Wei Chen) ； 林俊龍(Chin-Lon Lin) ； 張弘儒(Hong-Ru Chang)

《內科學誌》 26卷1期 (2015/02) Pp. 1-12

https://doi.org/10.6314/JIMT.2015.26(1).01

摘要

心血管疾病向來高居台灣主要死因的前幾名，對國人健康及醫療成本的影響甚鉅。傳統生理危險因子只能部分解釋疾病的發生與預後，隨著醫學研究的進展，心理社會危險因子越來越受到關注。實證研究顯示敵意（hostility）為影響心血管疾病發生與預後的危險因子；而憂鬱（depression）、焦慮（anxiety）、及D型人格（type D personality）則亦證實為影響死亡率的危險因子。這些心理社會危險因子可直接地影響心血管生理病理機制，包括透過自主神經、血壓、血糖、血脂、免疫與內皮細胞功能的機制，增加心血管疾病的風險；或是間接地經由不健康行為習慣，例如抽菸、喝酒或不遵從醫囑，進而造成心血管的不良後果。美國心臟學會以及美國心血管及肺臟復健學會，皆已將心理社會復健列入心臟復健核心元素之一。針對這些心理社會因子進行介入，不僅能夠降低心理與情緒困擾，提升健康行為，同時能夠改善內皮細胞與自主神經功能。在台灣，此等結合生理心理社會（bio-psycho-social）的多面向及多專業合作模式已建立並逐漸開展。有關心理社會層面的評估，本文僅提供一些簡短的測量工具，方便第一線臨床醫護人員使用，以提高對於患者情緒壓力的辨識度。患者若有心理社會問題，可轉介醫療院所臨床心理師提供專業的協助。

關鍵字

心理社會危險因子 ； 心臟復健 ； 憂鬱 ； 焦慮 ； 敵意 ； D型人格

並列摘要

Cardiovascular disease has always been the leading cause of death in Taiwan, and its impact on people's health and health care costs is enormous. Traditional physiological risk factors only partially explain the occurrence of and prognosis for the disease and psychosocial risk factors have recently received more attention. Empirical studies have shown that hostility is a risk factor and depression, anxiety, and Type D personality also have an impact on cardiovascular mortality. These psychosocial risk factors can directly affect pathology in the cardiovascular system through the autonomic nervous system, blood pressure, blood sugar, blood lipids, and immune and endothelial cell function. These psychosocial risk factors also have an indirect effect through unhealthy habits, such as smoking, drinking or not following doctors' orders. The American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation have both included psychological and social rehabilitation as core elements in cardiac rehabilitation. Modification of these psychosocial factors not only reduces psychological and emotional distress and improves healthy behaviors, but also improves endothelial cell and autonomic nervous system function. In Taiwan, the psychosocial aspects of the multi-faceted and multi-disciplinary collaboration model have been identified and gradually implemented. This article provides some brief psychosocial assessment tools for clinical staff use. If patients have psychosocial problems, they can then be referred to clinical psychologists for professional assistance.