| 2.1.Background and Objective:1.With the continuous development of dual-heart medicine,the psychological status of patients with coronary heart disease is becoming more and more concerned by clinicians.Coronary heart disease is a chronic disease.As a kind of psychosomatic disease,anxiety and depression and other unhealthy psychological conditions permeate the various course of coronary heart disease patients.Coronary angiography plays an important role in the diagnosis and treatment of coronary heart disease and plays an important role in the diagnosis and treatment of coronary heart disease.However,as an invasive operation,the patient often suffers from stress,anxiety,depression,and other unhealthy psychological conditions before surgery,and even leads to an increase in blood pressure and vasospasm during the operation that is not conducive to the smooth progress of the operation.A number of studies at home and abroad have recommended that patients undergoing coronary intervention should undergo routine psychological assessment prior to intervention.Patients with anxiety and depression should be given appropriate interventions to reduce fear of fear and fear before surgery and reduce intraoperative and postoperative outcomes.Discomfort caused by anxiety and depression improves patient's prognosis.2.There are a variety of anxiety and depression questionnaires currently used clinically,including Zung,SCL-90,Beck's Anxiety Depression Scale,Hospital Anxiety Depression Scale,and other self-assessment scales.Hamilton is also commonly referred to as an anxiety and depression scale.However,there are few comparative studies on anxiety and depression scale in patients with coronary heart disease,and lack of research on the characteristics of anxiety and depression in patients with coronary heart disease.3.This study investigated the preoperative coronary angiographic anxiety and depression status in coronary heart disease patients by using Zung's self-evaluation and Hamilton's other rating anxiety and depression scale,and analyzed and compared internal anxiety and depression somatic factors scores in the same anxiety and depressive state.Differing from the scores of mental factors,the characteristics of preoperative coronary angiography in patients with anxiety and depression were investigated.Compare the consistency of the two scale assessment results.Analysis of the factors that influence the consistency of the results of Zung's self-rated anxiety and depression scale and Hamilton's evaluation of anxiety and depression scale.It provides the basis for the selection of coronary angiography preoperative anxiety and depression scale for patients with coronary heart disease.2.2.Methods:A total of 251 patients with confirmed coronary heart disease who were scheduled for coronary angiography in the near future(1-3 days)were enrolled in the SAS and SDS questionnaires and HAMA and HAMD clinical evaluations.The statics were scored,compared,analysis and processing.The data were imported into SPSS21.0 statistical software for processing in the form of Excel table.The measurement data conforming to the normal distribution were described by means ± standard deviation.The counting data were analyzed by the chi-square test,The consistency of the results using Kappa consistency test,comparison between groups using t test.2.3.Results:1.Self-rating scale results: A total of 77 patients(30.67%)had anxiety(SAS?50scores),of which 49(19.52%)patients had mild anxiety,18(7.17%)patients had moderate anxiety,and 10(3.98%)patients showed severe anxiety by self-assessment.80 patients(31.87%)had depression(SDS?53 scores),of which 62(24.70%)had mild to moderate depression and 18(7.17%)had self-rated depression.63 patients combined anxiety and depression at the same time.2.SAS self-rating scale evaluation results showed that: somatic scores are higher higher than the spirit scores among mild anxiety patients,the difference was statistically significant(p = 0.002),physical scores and mental scores were not significant different among patients who had moderate to severe anxiety(p = 0.981,p = 0.805).SDS self-rating scale evaluation showed that mild to moderate depression in patients with physical disorder score higher than the psychological disorder score(p <0.001),the difference was statistically significant.There was no significant difference between somatic disorder score and mental disorder score in patients with major depression(p = 0.723).3.Others-rating scale results: A total of 78 patients(31.07%)had anxiety(HAMA>14scores).Among them,48(19.12%)patients had anxiety,21(8.37%)patients had obvious anxiety,and 9(3.58%)patients had severe anxiety.A total of 85 patients(33.87%)were depressed(HAMD>17scores).68(27.10%)patients had mild to moderate depression,17(6.77%)patients with severe depression.60 patients combined two negative emotions:anxiety and depression.4.The HAMA scale showed significantly higher somatic symptom scores(p < 0.001,p <0.001)in patients with mild anxiety and moderate anxiety compared with those in patients with severe anxiety.There was no significant difference in mental scores between physical scores and anxiety scores(p= 0.198).Patients with mild-severe depression assessed by HAMD had higher anxiety and somatic symptom scores than those with delayed or cognitive impairment(p < 0.001),indicating a significant difference in anxiety and anxiety scores between patients with severe somatic symptoms and those with severe depression Still relatively slow and cognitive total score(p = 0.024),the difference was still statistically significant.5.SAS and HAMA were highly consistent in assessing patients for anxiety(Kappa =0.916).However,in assessing the severity of anxiety in patients,consistency was moderate(Kappa = 0.401).There was a high degree of agreement between SDS and HAMD in assessing patients' depression(Kappa = 0.919).However,the consistency was moderate(Kappa = 0.466)when evaluating the severity of anxiety in patients.The self-rating and other-rating anxiety and depression scale were used to investigate the anxiety and depression status of the patients in this survey.The results showed that the two questionnaires had a good consistency(Kappa=0.860).6.The results of univariate analysis showed that the level of culture and completion of the self-assessment scale exceeded the usual 10 minutes.It was related to the consistency between the Zung's self-rated anxiety and depression scale and Hamilton's assessment of anxiety and depression scale(p=0.023,p).<0.001).The results of unconditional Logistic regression analysis showed that whether the completion of the self-assessment scale exceeds the usual 10 minutes is related to the consistency of the evaluation results of the Zung self-rating scale and the Hamilton other scale(p<0.001,OR=0.027,B=-3.628(95% CI=0.009,0.077)),independent of other factors.2.4.Conclusion:1.Anxiety and depression are common among the 251 CHD patients before their first angiography,indicating that in patients with coronary angiography should be strengthened to assess the psychological problems and intervention.2.Whether using the Hamilton Anxiety Depression Scale or the Zung Anxiety Depression Scale,this study shows that the majority of CHD patients with anxiety and /or depression have significantly lower levels of physical anxiety and depression than those with psychiatric anxiety and depression.Especially among the patients who had mild to moderate anxiety or depression.3.There is a high degree of emotional coherence among Zung Self-rating scales and Hamilton Other-rating scales in identifying patients with anxiety and depression.There is moderate consistency in determining the severity of anxiety and depression in patients with anxiety and depression.4.There are no significant difference among Zung Self-rating scales and Hamilton Other-rating scales in investigating the coexistence of anxiety and depression in patients with CHD.5.The completion of the self-assessment scale for more than 10 minutes will reduce the consistency of the Zung's self-assessment scale and Hamilton's assessment results. |
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