目的·评估焦虑障碍患者的焦虑水平、述情障碍程度与其生活质量之间的关系。方法·选择2020年10月1日—2023年3月31日期间在上海交通大学医学院附属精神卫生中心门诊收治的焦虑障碍患者为研究对象，经排除后最终纳入患者438例；其中，广泛性焦虑障碍患者271例，惊恐障碍患者101例，社交焦虑障碍患者48例，场所恐惧症患者12例，特定恐惧症患者6例。分别采用汉密尔顿焦虑量表（Hamilton Anxiety Scale，HAMA）、汉密尔顿抑郁量表-17项（Hamilton Depression Scale-17，HAMD-17）、多伦多述情障碍量表-20项（the twenty-item Toronto Alexithymia Scale，TAS-20）、世界卫生组织生活质量测定简表（World Health Organization Quality of Life Scale-Brief Form Questionnaire，WHOQOL-BREF）评估患者的焦虑水平、抑郁水平、述情障碍程度及生活质量，并对不同亚型焦虑障碍患者的量表得分进行评估。采用Spearman相关系数对焦虑障碍患者的焦虑水平、抑郁水平、述情障碍程度与生活质量进行相关分析，并使用逐步回归模型探索影响焦虑障碍患者生活质量的关键变量。结果·不同亚型焦虑障碍患者在HAMA评分、HAMD-17评分、TAS-20评分间的差异无统计学意义，但在WHOQOL-BRIEF评分上差异具有统计学意义（H=10.076，P=0.039）。Spearman相关分析的结果显示，焦虑障碍患者的WHOQOL-BRIEF评分与HAMA评分、HAMD-17评分、TAS-20评分均呈负相关（r=-0.256，P=0.000；r=-0.311，P=0.000；r=-0.342，P=0.000）。逐步回归分析的结果显示，年龄、HAMA评分、HAMD-17评分及TAS-20评分均对患者的生活质量有较大影响（均P<0.05）。结论·不同亚型焦虑障碍患者的生活质量有所不同，焦虑水平、抑郁水平及述情障碍程度均是影响焦虑障碍患者生活质量的关键变量。
关键词：焦虑障碍
;
焦虑水平
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抑郁水平
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述情障碍
;
生活质量
Abstract
Objective ·To evaluate the relationship between anxiety level, alexithymia degree and quality of life in patients with anxiety disorders. Methods ·Anxiety disorder patients admitted to the outpatient department of Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine from October 1, 2020 to March 31, 2023 were selected as the research subjects, and 438 patients were ultimately included after exclusion. Among them, there were 271 patients with generalized anxiety disorder, 101 patients with panic disorder, 48 patients with social anxiety disorder, 12 patients with agoraphobia, and 6 patients with specific phobia. Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale-17 (HAMD-17), the twenty-item Toronto Alexithymia Scale (TAS-20) and World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) were used to assess the patients' anxiety level, depression level, alexithymia degree and quality of life, respectively, and the scale scores of patients with different subtypes of anxiety disorders were evaluated. Spearman correlation coefficient was used to analyze the correlation between anxiety level, depression level, alexithymia degree and quality of life in patients with anxiety disorders. Stepwise regression model was used to analyze the key variables affecting the quality of life in patients with anxiety disorders. Results ·There were no significant differences in HAMA score, HAMD-17 score and TAS-20 score among patients with different subtypes of anxiety disorders, but the differences in WHOQOL-BRIEF score were statistically significant (H=10.076, P=0.039). The results of Spearman correlation analysis showed that the WHOQOL-BRIEF score of anxiety disorder patients was negatively correlated with HAMA score, HAMD-17 score and TAS-20 score (r=-0.256, P=0.000; r=-0.311, P=0.000; r=-0.342, P=0.000). The results of stepwise regression analysis showed that age, HAMA score, HAMD-17 score and TAS-20 score had significant impact on the quality of life of patients (all P<0.05). Conclusion ·The quality of life in patients with different subtypes of anxiety disorders is different. The anxiety level, depression level and alexithymia degree are the key variables affecting their quality of life.
Keywords：anxiety disorder
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anxiety level
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depression level
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alexithymia
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quality of life
SU Shanshan, JIANG Wenhui, WANG Shuting, XU Mizhen, REN Xueqing, QIU Jianyin. Impact of anxiety levels and alexithymia degree on the quality of life in patients with anxiety disorders. Journal of Shanghai Jiao Tong University (Medical Science)[J], 2024, 44(5): 584-590 doi:10.3969/j.issn.1674-8115.2024.05.006
焦虑障碍是我国患病率最高的精神障碍，其终生患病率和年患病率分别高达7.6%和5.0%［1］。该疾病存在不同的亚型，国际疾病分类第11版（International Classification of Diseases 11th Revision，ICD-11）中对焦虑障碍进行了最新的亚型分类，包含广泛性焦虑障碍、惊恐障碍、场所恐惧症、特定恐惧症、社交焦虑障碍、分离性焦虑障碍、选择性缄默症、其他焦虑及恐惧相关障碍。研究发现焦虑障碍对个体的精神健康和躯体健康均可造成负面影响，不仅会使其人际关系不稳定、上班缺勤率增加等，还会有更多的经济支出［2-4］，导致其生活质量出现明显下降。临床上，焦虑障碍患者的焦虑水平因人而异，不同程度的焦虑水平所致个体社会功能受损的程度往往不尽相同［5］。同时，焦虑障碍患者常伴有不同程度的述情障碍［6］。述情障碍作为一种长期存在的人格特质，主要表现为个体不能适当地表达内心情感、难以辨别内心体验和躯体感受，可严重影响个体的心理健康［7-8］。临床上，不同程度的述情障碍水平所致个体情绪智力（emotional intelligence，EI）的受损程度往往也不一样［6］。而社会功能受损和EI受损均会影响个体的生活质量。基于此，本研究假设焦虑障碍患者不同程度的焦虑水平、述情障碍水平均会对其生活质量带来不同程度的负面影响，我们采用Spearman相关系数对焦虑障碍患者的焦虑水平、抑郁水平、述情障碍程度与其生活质量开展相关性分析，并通过逐步回归模型分析影响该类患者生活质量的关键变量，以期为其生活质量的提升提供一定的参考。
多伦多述情障碍量表-20项（the twenty-item Toronto Alexithymia Scale，TAS-20）是用于评估述情障碍或情感表达困难的人格特征的量表。该量表为自评量表，包括20个条目，为5级评分，总分为20~100分；其中，≤51分为非述情障碍（低述情障碍水平），52~60分为中述情障碍，≥61为高述情障碍。TAS-20具有良好的信效度［12］。
（4）世界卫生组织生活质量测定量表简表
世界卫生组织生活质量测定简表（World Health Organization Quality of Life Scale-Brief Form Questionnaire，WHOQOL-BREF）由全球15个不同文化背景的WHOQOL研究中心讨论制定，在不同文化人群中均具有良好的信度和效度［13］。该量表为自评量表，由26个条目组成，采用1~5级评定，评分越高则生活质量越好。量表分为健康满意评价、心理感受质量、生活满意评价、能力感受质量共4个维度，这些维度分别对应生理、心理、社会和环境这4个领域；同时，该量表还包含2个独立分析的问题条目，即为个体自身生活质量总主观感受的生活质量（quality of life，QOL）自评、个体自身健康状况总主观感受的健康自评。
Tab 4 Correlation analysis among the scores of HAMA， HAMD-17， TAS-20 and the four dimensions of WHOQOL-BRIEF in patients with anxiety disorders ［r （P）］
SU Shanshan contributed to the design and implementation of the study, data collation, paper writing and revision. JIANG Wenhui and QIU Jianyin contributed to the design and implementation of the study, paper writing and revision. WANG Shuting, XU Mizhen and REN Xueqing contributed to the implementation of the study, and data collection and collation. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
COMPETING INTERESTS
All authors disclose no relevant conflict of interests.
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... 多伦多述情障碍量表-20项（the twenty-item Toronto Alexithymia Scale，TAS-20）是用于评估述情障碍或情感表达困难的人格特征的量表.该量表为自评量表，包括20个条目，为5级评分，总分为20~100分；其中，≤51分为非述情障碍（低述情障碍水平），52~60分为中述情障碍，≥61为高述情障碍.TAS-20具有良好的信效度［12］. ...
1
... 多伦多述情障碍量表-20项（the twenty-item Toronto Alexithymia Scale，TAS-20）是用于评估述情障碍或情感表达困难的人格特征的量表.该量表为自评量表，包括20个条目，为5级评分，总分为20~100分；其中，≤51分为非述情障碍（低述情障碍水平），52~60分为中述情障碍，≥61为高述情障碍.TAS-20具有良好的信效度［12］. ...
1
... 世界卫生组织生活质量测定简表（World Health Organization Quality of Life Scale-Brief Form Questionnaire，WHOQOL-BREF）由全球15个不同文化背景的WHOQOL研究中心讨论制定，在不同文化人群中均具有良好的信度和效度［13］.该量表为自评量表，由26个条目组成，采用1~5级评定，评分越高则生活质量越好.量表分为健康满意评价、心理感受质量、生活满意评价、能力感受质量共4个维度，这些维度分别对应生理、心理、社会和环境这4个领域；同时，该量表还包含2个独立分析的问题条目，即为个体自身生活质量总主观感受的生活质量（quality of life，QOL）自评、个体自身健康状况总主观感受的健康自评. ...
