德国成人先天性心脏病患者的心理健康治疗:现状、需求和治疗原因的在线横断面研究

IF 2.4 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Anna-Lena Ehmann, Emily Schütte, Janina Semmler, Felix Berger, Ulrike M M Bauer, Katharina Schmitt, Constanze Pfitzer, Paul C Helm
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引用次数: 0

摘要

改进的医疗方法延长了患有先天性心脏缺陷的成年人的生存期和预期寿命,更加重视心理社会健康。多达三分之一的ACHD患者会感到焦虑或抑郁,一半的人在一生中会患上精神疾病。虽然有确凿的证据表明心理健康普遍存在,但许多人没有接受心理、心理治疗或精神治疗(PST),心理护理情况仍未得到充分研究。在2024年第一季度进行的全国在线横断面调查中,1486名年龄在18至85岁之间的ACHD(年龄= 36.84岁;在德国国家先天性心脏缺陷登记处(NRCHD)登记的60.8%女性完成了关于社会人口统计、疾病身份(疾病身份问卷)、心理健康和PST使用的自我报告问卷。根据国际儿科和先天性心脏法典(IPCCC)确定冠心病的诊断,并根据Warnes等对冠心病进行分类(简单/中度/复杂)。分析包括卡方检验、t检验和二元逻辑回归。总体而言,32.8%的参与者报告当前和/或既往PST(女性37.5%,男性25.3%)。复杂冠心病患者的PST使用率(40.2%)明显高于中度冠心病(29.6%)和单纯性冠心病(25.3%)(ps < 0.01)。主要治疗原因是精神疾病(41.7%)和冠心病相关问题(37.2%)。近一半的治疗是自我发起的(45.8%),约三分之一是医生推荐的(30.8%)。Logistic回归显示,冠心病严重程度是PST使用的显著预测因子(ps < 0.05),在控制性别(p < 0.001, OR = 1.87)、年龄(p = 0.022, OR = 1.011)、教育水平(ps在0.060 ~ 0.780之间)和净收入(ps < 0.05)的情况下,单纯性冠心病(OR = 0.48)和中度冠心病(OR = 0.66)的概率低于复杂冠心病(p < 0.05)。接受PST治疗的患者表现出较高的适应不良疾病认同得分(吞噬、排斥)和较低的接受度。大约三分之一的冠心病患者需要心理健康支持,特别是那些患有复杂冠心病的患者。冠心病本身是一个关键的压力源和治疗动机。研究结果强调了将心脏病学和社会心理服务联系起来的综合护理的必要性。常规的心理困扰筛查和低门槛的pst治疗对于早期识别和解决心理健康需求至关重要,对于简单和中度冠心病患者也是如此。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Mental Health Treatment in Adults with Congenital Heart Disease in Germany: An Online, Cross-Sectional Study of Status, Needs, and Treatment Reasons.

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (Mage = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST-also for patients with simple and moderate CHD-are essential to identify and address mental health needs early.

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来源期刊
Journal of Cardiovascular Development and Disease
Journal of Cardiovascular Development and Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
12.50%
发文量
381
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