扬州市中老年慢性病共病患者焦虑抑郁症状的异质性及影响因素：潜在剖面分析-现代医学

扬州市中老年慢性病共病患者焦虑抑郁症状的异质性及影响因素：潜在剖面分析

单位：1. 扬州市疾病预防控制中心慢性非传染病防制科, 江苏扬州 225000;
2. 宝应县疾病预防控制中心慢性非传染病防制科, 江苏宝应 225800;
3. 扬州市邗江区槐泗社区卫生服务中心内科, 江苏扬州 225000

分类号：R181

出版年·卷·期（页码）：2025·53·第十一期（1711-1718）

摘要：

目的：通过潜在剖面分析(LPA)识别扬州市中老年慢性病共病患者焦虑抑郁症状的潜在亚组，揭示不同亚组的影响因素，为心理健康管理提供依据。方法： 2023年6~8月采用多阶段分层整群抽样，纳入≥45岁慢性病共病患者2 915例，采用患者健康问卷抑郁症状群量表(PHQ-9)和广泛性焦虑障碍量表(GAD-7)评估症状，利用LPA划分潜在亚组，结合Logistic回归分析风险因素。结果：共纳入抑郁症状患者663例，焦虑症状患者472例，抑郁合并焦虑患者402例，LPA结果可划分为5个潜在亚组：无症状组(51.22%)、轻度症状组(24.67%)、焦虑-躯体混合组(13.45%)、中度稳定组(6.66%)和重度症状组(4.01%)。多因素Logistic回归分析显示：与无症状组相比，(1) 轻度症状组：危险因素包括年龄≥65岁[OR=1.80(95%CI 1.45~2.24)]，文化程度为高中/职高/中专[OR=1.51(95%CI 1.02~2.25)]、大专及以上[OR=1.80(95%CI 1.08~3.00)]，慢性病数量≥4种[OR=1.87(95%CI 1.08~3.23)]；保护因素包括城市居住[OR=0.61(95%CI 0.50~0.74)]，个人月收入3 000~4 999元[OR=0.61(95%CI 0.47~0.81)]、5 000~7 999元[OR=0.57(95%CI 0.38~0.84)]。(2) 焦虑-躯体混合组：危险因素包括年龄≥65岁[OR=1.49(95%CI 1.13~1.97)]，慢性病数量3种[OR=1.62(95%CI 1.19~2.21)]、≥4种[OR=3.15(95%CI 1.74~5.71)]；保护因素包括城市居住[OR=0.48(95%CI 0.38~0.61)]，文化程度为初中[OR=0.71(95%CI 0.52~0.97)]、高中/职高/中专[OR=0.46(95%CI 0.26~0.81)]，个人月收入3 000~4 999元[OR=0.63(95%CI 0.44~0.89)]、5 000~7 999元[OR=0.46(95%CI 0.25~0.84)]。(3) 中度稳定组：危险因素包括年龄≥65岁[OR=1.68(95%CI 1.17~2.40)]，慢性病数量3种[OR=1.62(95%CI 1.08~2.41)]、≥4种[OR=3.40(95%CI 1.62~7.14)]，个人月收入1 500~2 999元[OR=1.91(95%CI 1.29~2.81)]；保护因素包括文化程度为大专及以上[OR=0.28(95%CI 0.08~0.96)]。(4) 重度症状组：危险因素包括年龄≥65岁[OR=1.63(95%CI 1.01~2.63)]，慢性病数量3种[OR=2.30(95%CI 1.43~3.70)]、≥4种[OR=8.12(95%CI 4.06~16.25)]；保护因素包括个人月收入3 000~4 999元[OR=0.33(95%CI 0.17~0.67)]、5 000~7 999元[OR=0.09(95%CI 0.01~0.67)]，已婚[OR=0.36(95%CI 0.15~0.86)]。结论：本研究揭示了中老年慢性病共病患者焦虑抑郁症状的异质性分布及关键驱动因素，为制定区域化分层心理干预策略提供了依据。

Objective: To identify latent subgroups of anxiety and depressive symptoms of middle-aged and elderly patients with chronic disease multimorbidity in Yangzhou by latent profile analysis(LPA), reveal the influencing factors of different subgroups, and provide a basis for mental health management. Method: From Jun. to Aug. 2023, multi-stage stratified cluster sampling was used to recruit 2 915 patients with chronic disease multimorbidity aged≥45 years. Symptoms were evaluated with the patient health questionnaire-9(PHQ-9) and the generalized anxiety disorder 7-item scale(GAD-7). Latent subgroups were identified using LPA, and risk factors were analyzed by Logistic regression. Result: A total of 663 patients with depressive symptoms, 472 with anxiety symptoms, and 402 with depression and anxiety were included. Latent profile analysis identified 5 latent subgroups: asymptomatic group(51.22%), mild symptom group(24.67%), anxiety-somatic mixed group(13.45%), moderately stable group(6.66%), and severe symptom group(4.01%). Multivariate Logistic regression analysis(compared with the asymptomatic group) showed that the mild symptom group had risk factors of age ≥65 years(OR=1.80,95% CI 1.45-2.24), high-school/vocational-high-school/technical-secondary education(OR=1.51,95%CI 1.02~2.25), college degree or above(OR=1.80,95%CI 1.08-3.00) and ≥4 chronic diseases(OR=1.87,95%CI 1.08-3.23), and protective factors of urban residence(OR=0.61,95%CI 0.50-0.74) and personal monthly income 3 000-4 999 yuan(OR=0.61,95%CI 0.47-0.81) or 5 000-7 999 yuan(OR=0.57,95%CI 0.38-0.84); the anxiety-somatic mixed group had risk factors of age ≥65 years(OR=1.49,95%CI 1.13-1.97), 3 chronic diseases(OR=1.62,95%CI 1.19-2.21) and ≥4 chronic diseases(OR=3.15,95%CI 1.74-5.71), and protective factors of urban residence(OR=0.48,95%CI 0.38-0.61), junior-high-school education(OR=0.71,95%CI 0.52-0.97) and high-school/vocational-high-school/technical-secondary education(OR=0.46,95%CI 0.26-0.81) and personal monthly income 3 000-4 999 yuan(OR=0.63,95%CI 0.44-0.89) or 5 000-7 999 yuan(OR=0.46,95%CI 0.25-0.84); the moderately stable group had risk factors of age ≥65 years(OR=1.68,95%CI 1.17-2.40), 3 chronic diseases(OR=1.62,95%CI 1.08-2.41), ≥4 chronic diseases(OR=3.40,95%CI 1.62-7.14) and personal monthly income 1 500-2 999 yuan(OR=1.91,95%CI 1.29-2.81), and protective factors of college degree or above(OR=0.28,95%CI 0.08-0.96); and the severe symptom group had risk factors of age ≥65 years(OR=1.63,95%CI 1.01-2.63), 3 chronic diseases(OR=2.30,95%CI 1.43-3.70) and ≥4 chronic diseases(OR=8.12,95%CI 4.06-16.25), and protective factors of personal monthly income of 3 000-4 999 yuan(OR=0.33,95%CI 0.17-0.67) or 5 000-7 999 yuan(OR=0.09,95%CI 0.01-0.67) and being married(OR=0.36,95%CI 0.15-0.86). Conclusion: This study reveals the heterogeneous distribution and key driving factors of anxiety and depressive symptoms among middle-aged and elderly patients with chronic disease multimorbidity, providing evidence for developing region-specific, tiered psychological interventions.

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