| 摘要 | 【目的】 评价重度到极重度成人语后聋患者的心理健康水平，探讨该群体可能广泛存在的不良心理状态以及相关影响因素；获得人工助听装置对耳聋群体精神心理状态改善趋势的影响作用；制定针对性的心理辅导方案缓解耳聋群体的不良情绪、改善适应不良性行为、促进人格成长。 【方法】 1. 采用自陈测试的评估方法，利用90项症状清单（Symptom Check List 90，SCL-90）、焦虑自评量表（Self-Rating Anxiety scale，SAS）、抑郁自评量表（Self-Rating Depression scale，SDS）和交流恐惧自陈量表（Personal Report of Communication Apprehension，PRCA-24）对耳聋患者的心理健康水平进行评价；采用中文版Nijmegen 人工耳蜗植入量表（Nijmegen Cochlear Implant Questionnaire, NCIQ）对人工耳蜗使用者的健康相关生活质量进行评估。 2. 通过与听力正常人进行对比，获得耳聋群体可能广泛存在的不良心理状态以及相关影响因素；通过对成人语后聋人工耳蜗使用者进行跟踪研究，获得人工助听装置对耳聋群体精神心理状态的改善趋势； 3. 对于存在明显不良心理健康状态的耳聋患者，在植入人工电子耳蜗改善听力的基础上，分别采用听觉言语康复训练、听觉言语康复训练辅以团体心理治疗的方案进行康复治疗，并分析不同康复方案对缓解不良情绪、改善适应不良性行为及促进人格成长的影响作用。 【结果】 1. 成人语后聋患者的精神心理特点及影响因素 (1) 使用SCL90量表对被试的精神心理状态进行全面评估，结果显示耳聋人群存在多种不良心理体验，其中“强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执和精神病性”八个因子分显著高于国内常模（One-sample t Test，p<0.01）。 (2) 使用SAS和SDS量表对被试的情绪障碍进行特异性评估，结果显示耳聋人群中普遍存在情绪情感不良体验，其中伴有焦虑症状者122人，占被试总数的48.22%，焦虑平均得分63.65；伴有抑郁症状者85人，占被试总数的33.60%，抑郁平均得分0.583。 (3) 使用PRCA24对本组被试的交流恐惧程度进行特异性评估，结果显示该群体存在明显的交流恐惧（One-sample t Test，p<0.01），检出中度以上交流恐惧225例（88.93%），并且随着交流人数的增加，耳聋人群的交流恐惧程度逐渐增加，公众交流场合最易导致耳聋者产生恐惧情绪。 (4) 对成人语后聋患者的精神心理评定结果进行二分类非条件logistic回归分析，结果显示被试性别、就诊年龄、耳聋持续的时间、是否伴有耳鸣、受教育程度、就业情况、家庭支持以及家庭经济状况等生理、病理、社会因素对其精神心理评定结果的影响程度具有统计学意义。 2. 康复方案对成人语后聋患者的精神心理状态影响的研究 (1) 人工听觉装置康复方案，仅能改善被试的短句识别能力明显提高（p<0.05），无法缓解被试的社交恐惧情绪。 (2) 人工听觉+系统听觉言语康复训练方案，在显著改善被试的听觉能力（p<0.01），并且改善的效果明显优于人工听觉装置康复方案（p =0.016），同时缓解了被试对二人间交谈的恐惧体验（p<0.05）。 (3) 人工听觉+系统听觉言语康复训练+团体心理支持治疗方案，在显著提高被试的听觉能力、改善社交恐惧体验、提高胜过质量（p<0.01）。 【结论】 成人语后聋患者的心理健康水平远远低于普遍水平、存在以焦虑和交流恐惧为主的多种不良心理体验，并受到性别、就诊年龄、耳聋持续的时间、是否伴有耳鸣、受教育程度、就业情况、家庭支持以及家庭经济状况等生理、病理、社会因素的影响。在听觉言语康复训练的基础上，辅以团体心理支持治疗，有助于人工助听装置使用者克服社交恐惧，改善生活质量。; 【Objective】 To evaluate the mental health level of the post-linguistic deafen adult, to analyze factors affecting the mental health level, to obtain the physical and mental health status of cochlear implantees, and then to explore the different effectiveness on physically and mentally healthy between hearing-speech rehabilitation and group psychotherapy. 【Methods】 1. The Symptom Checklist 90 (SCL-90), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and Personal Report of Communication Apprehension (PRCA-24) were used to measure the mental health degree of post-linguistic hearing loss people. Nijmegen Cochlear Implant Questionnaire (Chinese version) was used to measure the health related life quality assessment of these subjects. 2. To access the general unhealthy psychological status of hearing loss people compared with the normal hearing, to analyze related factors affecting the mental health level, to explore the trend of improvement in mental state of cochlear implantees 3. Applying group therapy cooperating with/or language training on psychological treatment for hearing loss with Cochlear Implants, comparing the patients’ emotional states and degree of social avoidance before with after treatment. 【Results】 1. Psychological Characteristics and effect factors of post-linguistic deafen adult (1) There was significant difference between post-linguistic deafen adult and normal hearing people in eight terror factors of SCL-90 evaluation (p<0.01), including obsessive-compulsive, social relation, depression, anxiety, hostility, terror, crankiness and psychosis. (2) The respective mean score of SAS and SDS was 63.65 and 0.583. The number of abnormal SAS result was 122 (48.22%) and abnormal result SDS was 85 (33.60%). (3) The number of abnormal PRCA-24 result was 225 (88.93%). The respective mean score of PRCA-24 was 75.28. This result was significant higher than the norm of American college students（One-Way ANOVA，p=0.001）. (4) Two classification of logistic regression was used for the data of patients having abnormal mental health. The result of regression suggests that gender, tinnitus, patient’s age, duration of hearing loss, education background, employment situation, family support, and economic conditions were significant correlation with the mental health condition. 2. The Effect of different rehabilitation programs on mental health condition of Cochlear Implants (1) Cochlear implant can only improve the subject's hearing（paired t test，p<0.05）, but failed to ease the Communication Apprehension of deafen people（paired t test，p>0.05）. (2) Cochlear implant +Speech rehabilitation program can both significantly improve the subjects of hearing ability（paired t test，p<0.01） and easing the fear of talking face to face（paired t test，p<0.05）. (3) Cochlear implant +Speech rehabilitation+ group therapy program can significantly increase the auditory abilities（paired t test，p<0.01）, reduce the communication Apprehension（paired t test，p<0.01）, and improve the quality of life. 【Conclusion】Compared with the normal hearing people, both post-linguistic deafen adult and cochlear implants still had obvious mental symptoms. It was very important to design an effective mental rehabilitation program to improvement the living quality of hearing loss people. |
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