肺高壓病患憂鬱程度及其影響因素

背景：肺高壓是罕見疾病且由於慢性症狀困擾，例如呼吸短促而長期影響病人的情緒的困擾。國外研究發現有憂鬱傾向的肺高壓病患整體存活率也較低。國內缺乏對於憂鬱的現況和其影響因素進行探討，因此本研究將進行此議題的調查。目的：本研究目的在探究肺高壓病患憂鬱和其他社會心理因素的相關性。方法：採橫斷式研究法(cross-sectional study)，對象包括20歲以上第一型和第四型的肺高壓病患，以及相同性別年齡配適之健康受試族群作為控制組。透過結構式問卷進行資料收集，包括：「基本資料量表」、「貝氏憂鬱量表」、「肺動脈高壓症狀干擾量表」、「親密關係量表」與「止觀覺察注意量表」。結果：本研究結果發現肺高壓組相較健康組的憂鬱程度及肺高壓症狀得分顯著較高，且達臨床憂鬱症狀的程度的比例: 肺高壓組有20.8%，而健康組只有2.8%。影響憂鬱的預測因子中，肺高壓組症狀越嚴重者與有工作者，憂鬱程度較高，健康組則是有伴侶者憂鬱程度較高。親密關係中的焦慮依附同時為肺高壓和健康組憂鬱的影響因素。路徑分析結果發現肺高壓組在控制職業因素下，正念覺察程度越高能降低症狀困擾造成的影響，進而降低憂鬱程度( 正念→肺高壓症狀→憂鬱)；而健康組於控制婚姻因素後，正念覺察能降低焦慮依附的程度而降低憂鬱程度 (正念→焦慮依附→憂鬱 )。結論：肺高壓組預測憂鬱的主要因素為肺高壓症狀困擾、職業狀態與親密關係中焦慮依附。另外正念覺察能透過緩解肺高壓症狀進而降低憂鬱症狀。建議未來推展預防肺高壓病患憂鬱之措施，包含門診症狀與身心狀態簡易篩檢，同時提供正念訓練提升症狀的自我照顧，以及促進安全依附親密關係的心理諮商。

關鍵字

肺高壓；憂鬱；身體症狀困擾；正念；親密關係的依附型態

並列摘要

Background: Pulmonary hypertension (PH) is a rare disease and its chronic symptom distress such as short of breath influences their emotional distress. The study found that the PH patients with depression are the high-risk group for lower survival rates. However, there is a lack of study in Taiwan examining depression and its associated factors in Taiwan. Therefore, this study emphasizes in this research issue. Purpose/Objectives: This study aimed to examine the depression among PH patients and its correlation with psychological factors. Methods: This study adopted the cross-sectional correlation design. The inclusion criteria of PH patients are that they are diagnosed as type 1 and type 4 pulmonary hypertension, and are aged at least 20 years old. The age-match healthy subjects are also recruited from community as control group. Data were collected by using structured questionnaires including “personal characteristics questionnaire,” “Beck Depression Inventory-II (BDI),”“Pulmonary Arterial Hypertension-Symptoms and Impact questionnaire (PAH-SYMPACT),”“The Experiences in Close Relationships-Revised (ECR-R),” and “Mindful Attention Awareness Scale(MAAS).” Results: This study found that in comparison with healthy control group, PH group appeared to have higher levels of depression and the clinical depression cases (20.8% vs 2.8%). In PH group, higher depression levels were associated with pulmonary arterial hypertension symptoms and were occurred in those with having a job. Differently, for control group, those with married endorsed with higher scores of depression. For both PH and control groups, higher scores of anxiety attachment style were associated with higher depression levels. The mediator analysis showed that in PH group, after controlling with job factor, higher mindfulness could reduce depression through its reducing the pulmonary arterial hypertension symptoms ( mindfulness→PH symptoms→depression). Differently, in control group, after controlling marital status, mindfulness could reduce depression by its reducing anxious attachment style in close relationship ( mindfulness→anxious attachment style→depression). Conclusion: Depression of PH patients is mainly associated with physical symptom distress, burden from job and anxious attachment style in close relationship. Moreover, mindfulness can reduce depression by its impacts on decreasing physical symptoms. Accordingly, the strategies for PAH depression program include screening depression status in outpatient department, providing mindfulness skill training to increase the capacity of self-care, and counseling to increase the secure attachment style in close relationship.