مطالعه ارتباط عوامل خطر ساز با شيوع افسردگي متعاقب سكته مغزي

The Relationship of Possible Risk Factors in Prevalence of Post Stroke Depression

زﻣﻴﻨﻪ و ﻫﺪف : اﻓﺴﺮدﮔﻲ ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐﺰی ﺷﺎﻳﻊ ﺗﺮﻳﻦ اﺧﺘﻼل ﺧﻠﻘﻲ در ﺑﻴﻤـﺎران ﻣﺒـﺘﻼ اﺳـﺖ . ﺳـﻜﺘﻪ ﻣﻐـﺰی ﻳﻜـﻲ از ﺑﻴﻤﺎر يﻫﺎی ﻧ ﻮروﻟﻮژﻳﻚ و از ﻣﺸﻜﻼت ﻋﻤﺪه ﺳﻼﻣﺖ ﻋﻤﻮﻣﻲ اﺳﺖ . ﻫﺪف از اﻳـﻦ ﻣﻄﺎﻟﻌـﻪ ﺗﻌﻴـﻴﻦ ﺷـﻴﻮع اﻓـﺴﺮدﮔﻲ ﻣﺘﻌﺎﻗـﺐ ﺳﻜﺘﻪ ﻣﻐﺰی و راﺑﻄﻪ آن ﺑﺎ ﻋﻮاﻣﻞ ﺧﻄﺮﺳﺎز ﻣﻲﺑﺎﺷﺪ. ﻣﻮاد و روش ﻫﺎ : اﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮرت ﺗﻮﺻﻴﻔﻲ ﺑﻪ روش ﻧﻤﻮﻧﻪ ﮔﻴﺮی در دﺳﺘﺮس، روی 116 ﺑﻴﻤﺎر ﻣﺒﺘﻼ ﺑﻪ ﺳﻜﺘﻪ ﻣﻐﺰی اﻳﺴﻜﻤﻴﻚ ﺑﺴﺘﺮی در ﺑﺨﺶ ﻣﻐﺰ و اﻋﺼﺎب ﺑﻴﻤﺎرﺳﺘﺎن ﺑـﻮﻋﻠﻲ ﺳـﻴﻨﺎ ﺳـﺎری اﻧﺠـﺎم ﮔﺮﻓـﺖ . ﺗـﺸﺨﻴﺺ ﺳـﻜﺘﻪ ﻣﻐـﺰی ﺑـﺮ اﺳـﺎس ﺗﺸﺨﻴﺺ ﺑﺎﻟﻴﻨﻲ ﻣﺘﺨﺼﺺ ﻣﻐﺰ و اﻋﺼﺎب ﺑﺎ اﺳﺘﻔﺎده از ﺳﻲ ﺗﻲ اﺳﻜﻦ ﻳﺎ ام آر آی ﻣﻐﺰ ﺗ ﺄﻳﻴـﺪ ﺷـﺪه ﺑـﻮد . ﻓﺮاواﻧـﻲ اﻓـﺴﺮدﮔﻲ ﺑـﺮ اﺳﺎس DSMIV و ﭘﺮﺳﺸﻨﺎﻣﻪ HADS ﺗﻌﻴﻴﻦ و ﻋﻮاﻣﻞ ﺧﻄﺮ ﺳﺎز ﺑﺮ اﺳﺎس ﻧﺘﺎﻳﺞ آزﻣﺎﻳﺸ ﺎت ﭘﺎرا ﻛﻠﻴﻨﻴﻜﻲ، ﭘﺲ از ﺗﻔﺴﻴﺮ و ﺗ ﺄﻳﻴﺪ ﻣﺘﺨﺼﺺ ﻫﻤﺮا ه ﺑﺎ اﻃﻼﻋﺎت دﻣﻮﮔﺮاﻓﻴﻚ در ﭘﺮﺳﺸﻨﺎﻣﻪ ﺛﺒﺖ ﺷﺪ. ﻧﺘﺎﻳﺞ ﺑﺎ اﺳﺘﻔﺎده از ﻧﺮم اﻓـﺰار spss16 و ﺗـﺴﺖ ﻫـﺎی آﻣـﺎری ﻛﺎی دو و رﮔﺮﺳﻴﻮن ﻟﺠﺴﺘﻴﻚ ﻣﻮرد ﺗﺠﺰﻳﻪ و ﺗﺤﻠﻴﻞ آﻣﺎری ﻗﺮار ﮔﺮﻓﺖ. ﻳﺎﻓﺘﻪ ﻫﺎ : ﻳﺎﻓﺘﻪﻫﺎی ﭘﮋوﻫﺶ ﻧﺸﺎن داد ﻛﻪ 47/4 درﺻﺪ ﺑﻴﻤﺎران دﭼﺎر اﻓﺴﺮدﮔﻲ ﺑﻮدﻧﺪ . ﻓﺮاواﻧﻲ اﻓـﺴﺮدﮔﻲ در زﻧـﺎن 29/3 درﺻﺪ و در ﻣﺮدان 18/1 درﺻﺪ ﺑﻮد . وﻓﻮر اﻓﺴﺮدﮔﻲ در زﻧﺎن ﺑ ﻪ ﻃﻮر ﻣﻌﻨﻲ داری ﺑﻴﺶ ﺗﺮ از ﻣﺮدان ﺑﻮ د. ﻫﻴﭻ ارﺗﺒﺎط ﻣﻌﻨـﻲ داری ﺑﻴﻦ اﻓﺴﺮدﮔﻲ ﺑﺎ ﺳﻦ و ﺳﻄﺢ ﺗﺤﺼﻴﻼت ﺑﻴﻤﺎران وﺟﻮد ﻧﺪاﺷﺖ وﻟﻲ ﺑﻴﻦ اﻓﺴﺮدﮔﻲ ﺑﻴﻤﺎران ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐﺰی و ﻋﻮاﻣﻞ ﺧﻄـﺮ ﺳﺎز ﺳﻜﺘﻪ ﻣﺎﻧﻨﺪ ﺟﻨﺲ، ﻗﻨﺪ ﺧﻮن ﺑﺎﻻ ( دﻳﺎﺑﺖ )، ﻓﺸﺎر ﺧﻮن ﺑﺎﻻ (ﻫﻴﭙﺮ ﺗﺎﻧﺴﻴﻮن )، ارﺗﺒﺎط ﻣﻌﻨ ﻲداری وﺟـﻮد داﺷـﺖ . ﺑـﺎ اﺳـﺘﻔﺎده آزﻣﻮن ﻛﻴﻔﻲ ﻣﺠﺬور ﻛﺎی دو، ﺑﻴﻤﺎری ﻫﺎی ﻗﻠﺒﻲ ارﺗﺒﺎط ﻣﻌﻨﻲ داری ﺑﺎ اﻓﺴﺮدﮔﻲ ﺑﻴﻤﺎران داﺷﺖ وﻟﻲ در رﮔﺮﺳـﻴﻮن ﻟﺠـﺴﺘﻴﻚ ﻓﺮﺿﻴﻪ ﺗﺤﻘﻴﻖ ﭘﻴﺶ ﺑﻴﻨﻲ و ﺗﺄﻳﻴﺪ ﻧﮕﺮدﻳﺪ. اﺳﺘﻨﺘﺎج: ﺑﻪ ﻃﻮر ﻛﻠﻲ ﻧﺘﺎﻳﺞ ﻧﺸﺎن ﻣﻲ دﻫﺪ ﻛﻪ اﻓﺴﺮدﮔﻲ ﻣﺘﻌﺎﻗـﺐ ﺳـﻜﺘﻪ ﻣﻐـﺰی از ﻓﺮاواﻧـﻲ ﺑـﺎﻻﻳﻲ در ﺟﺎﻣﻌـﻪ ﺑﺮﺧـﻮردار ﻣﻲﺑﺎﺷﺪ و اﻓﺴﺮدﮔﻲ ﭘﺲ از ﺳﻜﺘﻪ ﻣﻐـﺰی ﺑـﺎ ﻋﻮاﻣـﻞ ﺧﻄﺮﺳـﺎز ی ﻫـﻢ ﭼـﻮن ﺟـﻨﺲ ، دﻳﺎﺑـﺖ و ﻫﻴﭙﺮﺗﺎﻧـﺴﻴﻮن ارﺗﺒـﺎط دارد ﻛـﻪ ﺗﺸﺨﻴﺺ، درﻣﺎن و ﻣﺪاﺧﻠﻪ ﺑ ﻪ ﻣﻮﻗﻊ ﻣﻲ ﺗﻮاﻧﺪ از اﻓـﺴﺮد ﮔﻲ ﺑﻴﻤـﺎران، ﺧـﺼﻮﺻﺎً درﺟـﻨﺲ ﻣ ﺆﻧـﺚ ﻛﺎﺳـﺘﻪ و اﻣﻴـﺪ ﺑـﻪ زﻧـﺪﮔﻲ را اﻓﺰاﻳﺶ دﻫﺪ و در ﻧﻬﺎﻳﺖ ﻣﻨﺠﺮ ﺑﻪ ﺑﻬﺒﻮد ﻛﻴﻔﻴﺖ زﻧﺪﮔﻲ ﺑﻴﻤﺎران ﺧﻮاﻫﺪ ﺷﺪ.

Background and purpose: Post stroke depression is one of the common emotional disorders affecting stroke survivors. Stroke is one of neurological diseases and is a public health problem. The purpose of this study was to investigate the relationship of possible risk factors in prevalence of post stroke depression. Material and Methods: This descriptive study was performed using relevant sampling method on 116 inpatient ischemic stroke admitted in neurology department of Boali Sina hospital in Sari. The diagnosis of brain ischemic stroke was made based on the clinical findings of a neurologist and confirmed by Brain.C.T.S and M.R.I. Frequency of depression was determined using DSM IV criteria and HADS inquiry. The risk factors were recorded after being confirmed by a physician based on paraclinical testes along with demographic information. Data was analyzed applying Chi Square and logistic regression in SPSS V.16. Results: Finding revealed that 47.4% of the patients suffered post stroke depression. Frequency of depression was significantly higher in women (29.3%) compared to that in men which was (18.1%). There was no significant relation between depression and age and educational level. But we found a significant correlation between post stroke depression and gender, diabetes mellitus, and hypertension. Conclusion: This study showed a high incidence of depression after stroke which is found to be more prominent among women. There is a significant correlation between depression and sex, diabetes, and hypertension. Early diagnosis and proper interventions can help in decreasing the rate of post stroke depression especially in women, hence, the quality of life and expectancy of life will increase in these patients.