Objective: To explore the clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the cardiology department in general hospital. Methods: Cross-sectional survey method was used in this study. From August 2017 to September 2018, 508 outpatients of our department with suspected mental disorders, who complained of physical discomfort and screened by the "Three Questions" method recommended by the Chinese Expert Consensus on Psychological Prescriptions of Cardiovascular Patients in 2014, were consecutively included. General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Patient Health Questionnaire-15 (PHQ-15) and self-made general demographic questionnaire (including age, sex, marital status, educational level, occupation, duration of disease, clinical diagnosis and the process of medical treatment for the main somatic symptoms in recent one year) were used to investigate these patients, under the assistance of unified training psychological consultants. The detection rate of anxiety and depression, the degree and distribution of somatization symptoms in outpatients with mental disorders were analyzed, and the related factors affecting the occurrence of somatization symptoms were screened by multivariate logistic regression. Results: The selected patients were (51.3±10.1) years old, of which 37.8% (192/508) were males and 62.2% (316/508) were females. The total detection rate of anxiety/depression was 86.8% (441/508), and the detection rate of somatization symptoms was 93.1% (473/508). The number of positive symptom items in PHQ-15 was 8.0±2.7, and the detection rate of anxiety/depression was 78.6% (372/473) in patients with somatization symptoms. There were significant differences in the proportion of women, the average number of outpatient visits and hospitalizations in the past one year, GAD-7 score and PHQ-9 score among the patients with mild, moderate and severe somatization symptoms (all P<0.05). PHQ-15 score was positively correlated with GAD-7 score (r=0.524 5, P<0.001) and PHQ-9 score (r=0.574 9, P<0.001) in patients with somatization symptoms. Stepwise logistic regression analysis showed that total scores of PHQ-9 (OR=8.020, 95%CI 3.470-18.930, P<0.001) and GAD-7 (OR=6.526, 95%CI 2.903-13.045, P<0.001) and female (OR=4.440, 95%CI 1.059-9.073, P=0.011) were related factors of somatizations. Conclusions: The incidence of somatization symptoms is high in patients with psychological disorders in outpatients of cardiology department in general hospital. Anxiety, depression and gender are the main related risk factors of somatization symptoms in this patient cohort. Degree of anxiety and depression increased in proportion to the severity of somatization symptoms. Anxiety, depression and female is related to somatization symptoms.
目的： 探讨就诊于综合医院心内科门诊的心理障碍患者躯体化症状的临床特征，并分析其相关因素。 方法： 该研究为横断面调查。连续纳入2017年8月至2018年9月于中南大学湘雅医院心内科门诊就诊，以躯体不适为主诉、经2014年《在心血管科就诊患者的心理处方中国专家共识》推荐的"三问法"筛选，疑诊为心理障碍的患者508例。由经过统一培训的具有心理二级咨询师证书的协调员协助被试者完成一般人口学和临床资料（包括年龄、性别、婚姻状况、受教育程度、职业、病程、临床诊断及近1年内因目前主要躯体症状的就医诊治过程）的收集，以及广泛性焦虑量表（GAD-7）、患者健康问卷抑郁症状群量表（PHQ-9）、健康问卷躯体症状群量表（PHQ-15）的填写。分析门诊心理障碍患者焦虑、抑郁的检出率及躯体化症状的程度和分布情况，并采用多因素logistic回归筛选影响躯体化症状出现的相关因素。 结果： 入选患者年龄（51.3±10.1）岁，其中男性占37.8%（192/508），女性占62.2%（316/508）。508例有效病例中，焦虑、抑郁总检出率为86.8%（441/508），具有躯体化症状的患者占93.1%（473/508），PHQ-15量表评价结果显示阳性条目数为（8.0±2.7）条，在具有躯体化症状的患者中焦虑、抑郁检出率为78.6%（372/473）。轻、中和重度躯体症状患者间比较，女性构成比、近1年就医次数、GAD-7评分和PHQ-9评分的差异均有统计学意义（P均<0.05）。PHQ-15评分与GAD-7评分（r=0.524 5，P<0.001）和PHQ-9评分（r=0.574 9，P<0.001）均呈正相关。多因素logistic回归分析显示PHQ-9（OR=8.020，95%CI 3.470~18.930，P<0.001）和GAD-7评分（OR=6.526，95%CI 2.903~13.045，P<0.001）及女性（OR=4.440，95%CI 1.059~9.073，P=0.011）是躯体化症状的相关因素。 结论： 综合医院心内科门诊心理障碍患者躯体化症状发生率高，常见的心理障碍是焦虑、抑郁，躯体化症状程度越重伴随焦虑、抑郁越重。焦虑、抑郁和女性与躯体化症状相关。.
Keywords: Anxiety; Cardiovascular diseases; Depression; Outpatients; Somatic symptoms.