生活重建训练对慢性期脊髓损伤患者及其照顾者焦虑和抑郁的效果

doi:10.3969/j.issn.1006-9771.2025.11.010

Abstract

Abstract:

Objective To explore the effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury (SCI) and their caregivers, and to analyze the influencing factors.

Methods A total of 216 SCI patients and 79 caregivers who participated in life reconstruction training were recruited from the Hope House for SCI individuals in Shanghai Yangzhi Rehabilitation Hospital from May, 2017 to October, 2019. They were assessed with Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) before and after intervention.

Results After intervention, the scores of SAS and SDS decreased (P < 0.05) in both SCI patients and their caregivers. SAS scores were more likely to reduce in SCI patients who suffered anxiety at admission (OR = 2.315, 95%CI 1.328 to 4.033, P = 0.003) and their caregivers (OR = 3.632, 95%CI 1.270 to 10.390, P = 0.016), as well as non-agricultural-registered SCI patients (OR = 1.908, 95%CI 1.074 to 3.391, P = 0.028). Being unmarried, having an injury duration ≥ 21 years, injury due to disease, and having depression at admission significantly promoted the reduction in SDS scores among SCI patients (P < 0.05). Caregivers with a junior-high-school education or less were more likely to experience reductions in scores of SAS and SDS compared with those with higher education (P < 0.05). Caregivers with five to 15 years of caregiving experience achieved more anxiety reduction (OR = 7.155, 95%CI 1.806 to 28.342, P = 0.005).

Conclusion Life reconstruction training is effective on anxiety and depression among individuals with chronic SCI and their caregivers. It is recommended to prioritize anxiety interventions for patients with rural household registration in China, along with depression management for the married/divorced/widowed individuals, with < 21 years since injury, and trauma-induced lesions. For caregivers, it is needed to focus to anxiety and depression in better-educated individuals, as well as anxiety in those with either < 5 or ≥ 15 years of caregiving experience.

Key words: spinal cord injury, anxiety, depression, life reconstruction training, influencing factors

CLC Number:

R651.2

XIE Haixia, HU Xinxing, ZHAI Hua, LIN Peipei, HE Jianhui, ZHANG Jia, DONG Xiaowan, CHANG Fengshui. Effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury and their caregivers[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(11): 1333-1341.

Figures/Tables 6

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References 36

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变量		n
户籍地	上海	175
户籍地	外省市	41
性别	男	149
性别	女	67
户口	非农业	134
户口	农业	82
教育背景	初中及以下	109
	高中/中专/技校	63
	大专及以上	44
工作情况	有工作/学生	25
	无业	111
	退休	80
家庭年收入	< 5万元	108
	5万~10万元	75
	≥ 10万元	33
婚姻状况	未婚	51
	已婚	151
	离异/丧偶	14
受伤水平	颈段	77
	胸段	98
	腰骶段	41
损伤原因	外伤	173
损伤原因	疾病	43
严重程度	完全	125
严重程度	不完全	91
照顾者	无	135
照顾者	有	81
受伤年限	0.5~< 2年	69
受伤年限	2~< 6年	47
	6~< 21年	53
	≥ 21年	47

类别	严重程度	脊髓损伤患者		照顾者		脊髓损伤患者		照顾者
类别	严重程度	入院	出院	入院	出院	χ²/t值	P值	χ²/t值	P值
焦虑	正常/n	114	124	40	45	1.400^a	0.705	4.464^a	0.216
	轻度/n	59	50	19	24
	中度/n	33	34	12	7
	重度/n	10	8	8	3
	SAS	39.31±0.63	38.12±0.68	40.44±1.19	37.48±1.06	2.347^b	0.020	2.641^b	< 0.010
抑郁	正常/n	95	99	27	32	2.623^a	0.453	1.837^a	0.607
	轻度/n	66	69	28	24
	中度/n	38	39	18	20
	重度/n	17	9	6	3
	SDS	43.83±0.69	42.67±0.70	45.42±1.18	42.57±1.21	1.977^b	0.049	2.700^b	0.008

类别	自变量		偏回归系数	SE	Wald值	OR值	95%CI		P值
类别	自变量		偏回归系数	SE	Wald值	OR值	下限	上限	P值
脊髓损伤患者	户口	农业	0.000
	户口	非农业	0.646	0.293	4.855	1.908	1.074	3.391	0.028
	入院时焦虑	无	0.000
	入院时焦虑	有	0.839	0.283	8.772	2.315	1.328	4.033	0.003
照顾者	教育背景	高中及以上	0.000
	教育背景	初中及以下	1.512	0.630	5.768	4.537	1.321	15.589	0.016
	累计照顾时间	< 5年或≥ 15年	0.000
	累计照顾时间	5~< 15年	1.968	0.702	7.851	7.155	1.806	28.342	0.005
	入院时焦虑	无	0.000
	入院时焦虑	有	1.290	0.536	5.784	3.632	1.270	10.390	0.016

类别	自变量		偏回归系数	SE	Wald值	OR值	95%CI		P值
类别	自变量		偏回归系数	SE	Wald值	OR值	下限	上限	P值
脊髓损伤患者	婚姻状态	已婚/离异/丧偶	0.000
	婚姻状态	未婚	0.778	0.367	4.490	2.178	1.060	4.473	0.034
	受伤年限	< 21年	0.000
	受伤年限	≥ 21年	0.774	0.381	4.126	2.168	1.028	4.573	0.042
	损伤原因	外伤	0.000
	损伤原因	疾病	0.803	0.365	4.833	2.231	1.091	4.563	0.028
	入院时抑郁	无	0.000
	入院时抑郁	有	0.811	0.299	7.349	2.251	1.252	4.047	0.007
照顾者	教育背景	高中及以上	0.000
照顾者	教育背景	初中及以下	1.179	0.559	4.438	3.250	1.086	9.730	0.035

Effect of life reconstruction training on anxiety and depression among individuals with chronic spinal cord injury and their caregivers

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变量		焦虑显著降分		抑郁显著降分		焦虑显著降分		抑郁显著降分
变量		无	有	无	有	χ²值	P值	χ²值	P值
户籍地	上海	86	89	94	81	3.718	0.054	0.083	0.773
户籍地	外省市	27	14	21	20
性别	男	81	68	81	68	0.807	0.369	0.243	0.622
性别	女	32	35	34	33
年龄	18~52岁	65	46	53	58	3.568	0.059	2.768	0.096
年龄	53~70岁	48	57	62	43
户口	非农业	63	71	65	69	3.974	0.046	3.177	0.075
户口	农业	50	32	50	32
教育背景	初中及以下	56	53	57	52	0.455	0.797	0.610	0.737
	高中/中专/技校	32	31	36	27
	大专及以上	25	19	22	22
婚姻状况	未婚	26	25	18	33	0.167	0.920	8.654	0.013
	已婚	79	72	89	62
	离异/丧偶	8	6	8	6
工作情况	有工作/学生	13	12	10	15	5.362	0.069	2.779	0.249
	无业	66	45	58	53
	退休	34	46	47	33
家庭年收入	< 5万元	55	53	58	50	0.453	0.797	0.078	0.962
	5~< 10万元	39	36	39	36
	≥ 10万元	19	14	18	15
受伤年限	0.5~< 2年	38	31	40	29	0.802	0.849	7.855	0.049
	2~< 6年	25	22	25	22
	6~< 21年	28	25	33	20
	≥ 21年	22	25	17	30
受伤水平	颈段	41	36	50	27	1.495	0.474	7.037	0.030
	胸段	54	44	44	54
	腰骶段	18	23	21	20
损伤原因	外伤	94	79	99	74	1.422	0.233	5.543	0.019
损伤原因	疾病	19	24	16	27
严重程度	完全	70	55	68	57	1.615	0.204	0.160	0.689
严重程度	不完全	43	48	47	44
是否有照顾者	无	70	63	67	66	0.014	0.906	1.141	0.285
是否有照顾者	有	43	40	48	35
入院时焦虑/抑郁情况	无	70	44	59	36	7.994	0.005	5.353	0.021
入院时焦虑/抑郁情况	有	43	59	56	65

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变量		n	焦虑显著降分		抑郁显著降分		焦虑显著降分		抑郁显著降分
变量		n	无	有	无	有	χ²值	P值	χ²值	P值
性别	男性	15	8	7	9	6	0.015	0.902	0.347	0.556
性别	女性	64	33	31	33	31
年龄	27~58岁	43	23	20	20	23	0.096	0.757	1.677	0.195
年龄	59~76岁	36	18	18	22	14
与脊髓损伤患者关系	配偶	50	25	25	30	20	0.197	0.657	2.556	0.110
与脊髓损伤患者关系	其他	29	16	13	12	17
教育背景	初中及以下	19	5	14	6	13	6.559	0.038	4.681	0.096
	高中/中专/技校	40	24	16	24	16
	大专及以上	20	12	8	12	8
工作情况	有工作	11	6	5	6	5	0.068	0.967	1.093	0.386
	无业	24	12	12	10	14
	退休	44	23	21	26	18
每天照顾时间	< 12 h	13	6	7	6	7	0.021	0.650	0.307	0.579
每天照顾时间	≥ 12 h	66	35	31	36	30
累计照顾时间	0~< 2年	32	19	13	17	15	6.222	0.101	1.014	0.798
	2~< 5年	14	9	5	9	5
	5~< 15年	16	4	12	8	8
	≥ 15年	17	9	8	8	9
自身健康状况	比5年前好/和5年前一样	15	7	8	7	8	6.645	0.036	2.009	0.366
	比5年前略差	30	21	9	19	11
	明显比5年前要差	34	13	21	16	18
入院时焦虑/抑郁情况	无	40	26	14	14	13	5.571	0.018	0.028	0.866
入院时焦虑/抑郁情况	有	39	15	24	28	24