Trầm cảm ở phụ nữ việt nam

TRAM C A M PHU NQ VIET NAM Nghidn cihi la mdt phan cua de tai: Phu nit bi bao liK gia dinh dt/tx TruiJng Oai hpc Vanderbilt tai ira PGS.TS 06 Ngpc Khanh Tnrdng phdng Phong Tdm ly hoc Idm sdng \ ien Tdm ly hpc PGS.TS Bahr Weiss Khoa Peahody, Dai hoc Vanderbilt, I loa Ky I TOM TAT Trdm cdm Id mpt trpng nhimg rpi lpan tdm Ihdn phd biin nhdt vd gdy nhieu Idn hai vi sire khoe vd ldi ehinh nhdl cdc logi henh ve sire khoe tdm thdn Ty If trdm cam a phu nir cao hon gdp hai ldn so vai nam giin O I iet Xam cdc nghiin cira khdc dua cdc ly le trdm cdm khdc tiiy thudc vc'ip timg vung dia ly cua khdch thi nghien ciru \ghiin ciru ndy thuc Men v&i 243 phu nir dd kit hdn a tinh thdnh trpng ca nuac Kit qua nghien ciru cho thdy, ly li I rdm cam a phu nir Viil N'li" Id 5.0% Xhirng nguai sdng d ndng ihon cd nguy ca hi trdm cam cao him nhirng ngudi sdng a thdnh phd Phu nir Irong dp tudi tir 30 din 50 cd mirc dp trdm cam cao han so vdi phu nu dudi 30 tudi vd Iren 50 tudi Nhimg phu nir hi hao hdnh cd nguy ca hi trdm cdm cao han nhirng phu nir khdng hi bgo hdnh Thai gian ket hdn cdng ddi ihi mifL dp trdm cam cdng cao Tir khoa: Trdm cdm: Rdi hgn Idm thdn: Trdm cdm a phu nir Viet Nam \gdy nhdnbdi 20/7/2015; \giiy duyet ddng hdi 25/12/2016 ABSTRACT Depression is one Ihe most common mental disorders It causes the greatest health and financial losses among mental health illnesses The rale of depression in women is IMice higher than that of men In Vietnam, different studies give different rates of people with depression, depending on Ihe geographical area.s of the stuliy participants This study conducted with 243 married women who come from provinces and cities in Vietnam The results indicated that 5% of Vietnamese women have depres\ion People living in rural areas tend lo have higher risk of depres.sion than those living in cities Women aged 30 lo 50 had higher seventy of depression than ll omen under 30 and over 50 years old The abused women are at higher risk of depression Ihan those who are not abused Among these women, the longer duration of marriage, the higher the level of depression Key words: Depression Mental disorders: Depression among Vietnamese women 50 TAP CHI' TAM LV HOC, S6 (214), - 2017 Ly nghien ciru Tram cam (depression) la mot nhimg roi loan tam than bien nhat cae loai benh \ c sire khoe lam than Tram cam la benh xuat hien dong Ihdi vdi cac benh khae cao nhat 'ITico To chiie Y te The gidi tren the gidi co khoang 200 trieu ngudi chiem gan 5,0°'o dan so cd cae trieu chiing tram cam dicn hinh Rieng d Viet Nam ty le ngudi bi lr§m cam la 2.8°o (WHO 2000) Nhicu nghien ciru eho lha> t\ lc phu nii bi tram cam eao htm nam gidl il nhat lan (1)SM-1\'| Co nhieu nguyen nhan dan den Iram cam mdt nhirng ngu>en nhan \e mat xa hpi la ap lue cudc song Phu nir thudng chju nhicu ap luc cupc song gia dinh hon nam gidi nhai la d Vict Nam noi van nhieu dinh kicn \c gidi Day co the la nuu\cn nhan dan den vice phu nir co t\ lc tram cam cao ban nam gidi Tram cam ciing la benh ga) nhicu ton hai \c kinh te \a la benh ga\ ihucmg tat Urn nhat cac loai benh tat eiia eon ngudi I y le ngudi tu sat tram cam nga> cang tang cao tren the gidi chiem 46.0% so ngudi tu sal (Bourgeois, 1998) O Vict Nam nhiing nam gan da\, van de siic khde tam than noi chung vT tram cam ndi rieng da dupc Chinh phti eae co quan chiic nang va cac nha nghien ciiu quan tam dac biet Nam 2012, Chinh phii da dua dc an 1215 Trp giiip xa hpi va phue hoi ehirc nang cho ngudi lam than, nguiifi roi nhicu tam iri dua vao cong ddng giai doan 2011 - 2020 Nhieu cong trinh nghien cim khoa hpe ve tram cam dupc lien hanh vdi cac qu\ mo khac Cac nghien ciiu ve dich tc hoc cung da dua so thong kc khae vc tram cam nhu nghien ciiu cua Ngd Ngpc lan \a Cao T icn Dire (2001) d mot phutmg cho thay ty le ngudi mac benh tram cam la 3.4"o Trong tac gia La Thi Budi phat hien CO 4.l*'.o ngudi mac benh tram cam d mot phudng mpt ldn Nghien cuu khac ciia \gu>cn Van SiC'm va cpng su d mot xa \iing nong thon eho thii) ty lc mac Irani cam la 8.35"o dan so (dan theo Ngu\cn Kim Viet 2006) Cac nghien cuu lap trung vao tim hicu tir goc dp dich ic hpc ehua lim nhirng khae biet \e muc dp tram cam theo mpt so \cu to khac, dac biet chua CO nghien cuu nao tap trung nghien ciru \an dc tram cam d phu nir co gia dinh Nghien cuu nham tim hicu tram cam d phu nii d eac viing mien khac ca nudc de co dupc birc tranh chung vc tram cam IT phu nii Viet Nam la can thiet Khai niem tram cam Co nhieu lac gia dua cac khai niem cung nhu bieu hicn khac eiia tram cam Tuy nhien, nghien cim na) ehiing toi six dung khai niem tram cam cua Hiep hpi Tam ly hpc Hoa K\ Iheo trdm cdm la trang thai buon chan \a mai himg thii \(Ti cac hoat dong co the anh hudng den cac suy nghT hanh \i cam xiic va cam giac hanh phuc ciia ca nhan Nhirng ngudi tram cam cam th^y bu6n lo TAP CHi TAM LV HOC, Sd' (214), -2017 51 au, U-dng long, vd \ong lo ling, bit lure, khdng cd gia tri, mSc cam tdi ldi, de can kinh, dau ddn, khdng thd thu gian (Salmans, Sandra, 1997) Up cd the mat thit tham gia eac boat ddng mang lai nidm \aii, mit cam giac ngon mieng hoac an qua nhidu gap khd khan lap tmng chu > ghi nhd chi tidt dua i^ cac quyet djnh va cd thd ed y nghi hoac da thu lir sat mat ngu hoac ngu qua nhieu, mdi met, mit nang lupng dau nhue co thd hoac cd cae van de ve lieu hda ("NIMI1 » Depression" 2012) Nguyen nhan tram earn Cd nhidu nghien cim vd nguyen nhan tram cam, vi vay, cac each giai thich vd CO chd tao trim cam la khac Ndi bat la cac hudng tiep can tir gde sinh hpc mdi trucmg sdng nhan thire va hanh vi - Cae nghien cira tram cam tu gde sinh hpc tap trung vao nghien ciru thuc trang tram cam cua eac \ien gia dinh cac cSp song sinh nghien cuu mdi quan he gitta tram cam cua cha mc rupl vdi nhttng dira da cho lam nudi cac gia dinh khac nghien eiru eo che sinh hda, nghien cim > eu td van hda xa hdi dc tim mdi quan he gitta gen di truyen va tram cam Cac ket qua nghien cuu tram cam cua vien gia dinh cho thay, gen di truyen cd kha nang la tac nhan gay tram cam Nhttng ngudi cd mdi quan h? gan vdi ngudi dupc chan doan tram cam (vi du, nhttng ngudi nhu anh em, con, bd me ed 50% citng gen) cd kha nang bi tram cam nhicu hon gap den lan so vdi nhirng nguoi ma hp hang gan cua hp khdng bi tram cam (Oruc va edng s\r, 1998) Nghicii cira gan day nhat ciia I'rankel va edng su (2010) cung eho thiy trieu chung tram cam cao d cha me ed tuong quan vdi trieu chirng trim cam eao d Cac nha nghien cuu cac cap song sinh khing djnh ring, trim cam la gen di iru>cn Ket qua njhien eOni cho thiy, cac eSp song sinh cimg trimg cd ty le ca hai bj trim cam nhicu hon cac cap song sinh khac tning vdi ty le la 46% so vdi 20% (McGurtln ya edng su, 1996) Tuy nhidn, vi nghien cijm gia dinh va cic cap song sinh ed didm ydu la thucmg hp cimg cd mdi trudng sdng gidng nen khd khang djnh tram cam mdi trudng huy gen Chinh vi vay, nhttng nghien cuu ve nudi giitp giai quydt didm yeu Nhttng nghidn cira nudi da so sanh nhQng ngudi dupe nhan nudi cdn nhd vdi cac anh em rupt vS anh em nudi Kcl qua cho thiy, mac dii sdng xa cha me rupt va dupc nudi mdt mdi trudng hoan loan khac (ydu Id trim cam phat sinh mdi trudng dupc loai bd) nhung van cd mdi tuong quan thuan gitta mue dp trim cam d nhttng ngudi dupe eho lam nudi va bd me rupt cua hp (Wendcr va cpng s\f, 1986) Phan Idn cae nghien eira ehi ring, nhttng dua Ire nudi bi trim cam cd Chan doan tuong tu nhu anh cm rudt nhidu hon anh cm nudi 20% so vdi - 10% (Harrington va cdng su 1993) Cac nghien cuu sinh hda tap Uung vao nghien ciiu cac ehat dan Uuycn than kinh tac ddng ddn trim cam Ngudi ta thiy ring, cac '^ TAPCH(TAMLyH0C.S6 1(214), 1-2017 ehat ga\ nghien thudng co tac dung giam irieu chiing cua roi loan cam xiic don cue Mot nhom thudc gay nghien lam tang chai dan truyen than kinh serotonin \a noradrenaline Nghien cim ciia Schildkraul (1965) dua tren co sd l\ ihuyci eho rang, sinh boa dong vai tro quan trpng Irong tram cam da dua gia ihuycl rang qua nhicu chat noradrenaline gay cam qua it chat ga\ Uam cam Nghien cim sau ciing eho thay serotonin cung dong vai tro luong tu - Cac nghien ciiu ve \ cu to van hoa xa hoi nhu la nguyen nhan ciia tram cam gom nghien ciiu ciia Brown va Harris (1978), nghien eiiu ciia Nolen -1 loeksema (1990) Cae kei qua thu dupe lir nghien ciiu ciia cac tac \ c cae nhom phu nii CO hoan eanh kinh le xa hpi khac cho thay cac nhdm phu nii ed miic dp tram cam khac Cac nghien ciiu \e gidi tinh cho thay phu nii co t\ !e tram cam cao hon gap lan nam gidi bdi vai tro cua phu nu gia dinh \'a xa hpi khac biel vdi nam gidi phu nii ehiu nhieu ap tuc hon nam gidi phai ganh vac nhicu traeh nhiem hon nam gidi gia dinh nhung lai co chat lupng eupc song thap ban nam gidi Mat khac phu nii thudng lam nhiing cong vice eo \ i the thap, thudng bi qua tai \ e cong viec co quan \'a cdng \ icc nha chju nhicu ap lire ve mat van hoa hon so vdi nam gidi \i \ a \ dc bi cang thang Nghien cihi ciia I-ranke! va edng su (2010) chi ring, mau thuan Irong hon nhan co tmmg quan CO y nghTa vdi trieu chiing tram cam ciia cha me \ a eon va mdi tuong quan na\' la khac ihco gidi tinh ciia cha me va eon Dae biet mdi quan he giira eac trieu chiing tram cam ciia cha me \ a cac to nhat dinh ciia bdi canh gia dinh manh hon doi vdi gai so vdi Uai mdi tuong quan giiia cac to boi canh gia dinh va cac trieu chirng iram cam cua eon manh hon doi vdi me so sanh vdi cha - Nguyen nhan Uain cam dupc ly giai dua vao diuyet hdnh vi (Lcwinsohn (1979) Seligman (1975)) Cae luc gia cho rJng, tram cam la kcl qua cua qua trinh hpc tap qua quan sat, ngudi tram cam il nhan dupc cac ciing co lich cue tir xa hdi hp hi lusct vpng lap nhiem Nhiing ngudi tram cam hpc dupc rang, mdi Irudng sinh !> \a xa hpi nam ngoai kha nang kiem soat eiia ca nhan vi \a> hp khdng co gang de thoat khoi nhiing dicu kicn kho khan \'hd!i ihirc lieu cue la mpt nhiing nguyen nhan ciia tram cam dupc Beck (1997) khang dinh Theo ong tram cam bat ngudn lir nhan ihLre sai lech trudc nhiing sir kien anh hudng den ngudi Con ngudi cd nhung loi nhan thiic nhu khai quat hoa qua miic triru lupng hoa co chpn Ipc, khiing hoang hda van de, nhiing su\ nghT am anh lam anh hudng den niem tin vc ban than, vc the gidi xung quanh va vc tuong lai ciia hp Phyong phap nghien ciru Nghien ciru dupc thuc hien tren 243 phu nu da ket hdn d Ha Ndi, Quang Ninh, Dong Nai Quang Ngai \a Thanh Hoa Tuoi Irung binh eua khaeh TAPCHfTAMLVHOCSdl (214), -2017 53 thd nghien cuu la 30,06 dd luoi thip nhat la 17 va cao nhat la 60 Khach thd dupc chpn mdt each nglu nhien ti;ong danh sach phu nu cua phudng T?i Ha Not khach thd la nhirng phii ntt sdng ndi Ihanh (cu dan thj) T|i bdn tinh Quang Ninh Ddng Nai Quang Ngai va Ihanh Hda khach the la nhttng phu nu sinh sdng tai cac vung ndng thdn Trong nghien cim chitng tdi dung thang Tram cam PHQ-9 Thang PHQ-9 dupc du an "Thuc ddy chdm sdc sire khde ldm ihdn dtra vdo cdng ddng: thi diim md hinh chdm sdc kit hop tirng btr&c" Quy Cuu chien binh My tai Viet Nam thyc hicn djch va sua ddi thich nghi nen c(3 dp hieu lue \a dp tin cay cao dung cho ngudi Viet Nam Bang PHQ-9 gdm cau hdi ve mat nhan thuc, cam xuc, hanh vi sinh ly Nhihig uieu chung phai keo dai il nhat tuan Mdi cau tra ldi dupc gan cho gia trj tu - 3, theo muc dp tang dan: (0) khdng nap, (I) vai ( - nga)) (2) hon mdt nua sd ttong hai tuan ( - 1 ngay) (3) gan nhu mpi (12- 14 ngay) Trong nghien cim nay, he sd Alpha eua Cronbach ciia thang la 0,89 cho thay dp tin cay tdt De danh gia muc dp \a theo ddi can linh diem va phan loai Caeh tinh diem nhu sau: cdng diem cua tat ea cac cau Itt ddn tdng diem cao nhat se la 27 Viec phan loai theo ldng didm dupc tinh nhu sau: ^ Dicm - : Khdng tram cam; + Diem - : Trieu chirng ldi thidu cd nguy ep; t Dicm 10 - 14: TVam cam nhe; + Dicm 15 - 19: Tram cam vtta; + Dicm 20 - 27: Tram cam nang Ket qua nghien eihi u Ty If phu nir hi Iram cdm Kcl qua nghien cuu chi d bang cho thiy, cd hom mpt nua sd khaeh th^ nghien cuu khdng cd diu hieu trim cam, 30,9% sd phu nO cd nguy co trim cam Mire dp phu ntt bj trim cam nhi; la 11,1%, trim cam vua la 3,3% va muc dp nang la 1,6% tdng sd phu ntt dupc nghien ciru Nhu vay ty Id phu nu nhdm khach the nghien cuu bj trim cam tu nhe ddn nSng chidm khoang 16% va neu chi tinh t\ le phu ntt bj trim cam vua va nang la gin 5% So sanh ket qua nghien ciru ciia chimg tdi vdi kdt qua nghien cuu d My vdi phat hipn cd tu den 9°'o sd phu ntt \1> bj trim cam vua va nang, nam gidi My bj tram cam ehi chiem tu den 3% eho thiy kdt qua nghien cira la phu hpp vdi tinh hinh chung tren thd gidi, luy nhien nim d ngung thip TAP C H I T A M L f HOC, 86' (214), - 2017 Vi d Viet Nam ehua cd nghien ciru nao vc tram cam d phu ntt thep each thuc tuong tu nen rat khd so sanh ket qua Tuy nhien so sanh ket qua nghien cuu vdi cae ket qua nghien ciru cua cac nha khoa hpc di trudc d Viet Nam tren mau chung ca nam va ntt thi thay ty le phu ntt nghien ciru cua chiing tdi bi tram cam cao han ty le ngudi bi tram cam d khu vuc thj (2.8% nghien cira dich te hpc benh tam than cua Tran Van Cudng (2002) d cac viing dd thi khac nhau; 3,4% va 4,1% nghien cuu ctia Ngd Ngpc Tan Cao Tien Due (2001) va La Thj Budi a vung thj) nhung thdp han so vdi ket qua nghien ciru nhdm khach the d ndng thdn cua Nguydn Van Siem la 8.35% tren tdng khach the nghien cira Cac sd khac cd the la mau cua ehung tdi la phu ntt, vi vay se eao ban so vdi cac mau chung d vung thj hay cac vimg kinh te xa hdi khac luy nhien, mau cd dai dien ca ndng thdn lan thj nen ty- le thap hon so vdi nghien curu d cac vung ndng thdn rieng biet Cac nghien cira cho thay, ty le sd ngudi dan bi tram cam d nhirng vung ndng thdn va kinh te kem sS eao hem neu so vdi khu vye thj va kinh te phat trien Bang I: Ty li phu nir bi trdm cdm theo cdc mirc dp Ty 1^ % phu nu tram cam Khong CO bieu hi^n Co nguy Cff Mirc dp nhe Mirc dp vira Mure dp nSng 53.1 30,9 IIJ 3,3 1,6 b Mure dp tram cdm a phu nir cd dp tuoi khdc Theo bao cao mdi nhat ciia Trung lam Kiem soat va Phong ngira Dich b?nh Hoa Ky (CDC), benh tram cam tang theo ty le thuan vdi ludi, ly le ngudi mSe benh tram cam dp tuoi 12 - 17 la 5,7% nhung den dp ludi 40 - 59 ty le la 9,8% d ca hai gidi Rieng nhom ngudi d eae eo sd dieu tri than kinh tbi ly I? mac b?nh eao hem, mac dii dupc dieu tri so vdi nhiing ngudi binh thudng Ket qua nghien ciiu ciia chiing toi cung phu hpp vdi kei qua bao cao ciia CDC cac so bang cho Ihay co mdi luong quan thuan giCia dp tudi va diem trung binh ciia miic dp tram cam cua khach the nghien ciru Ngudi eang nhieu tuoi eang co diem irung binh miic dp tram cam cao hon ngudi it ludi (R2 = 0.16 vdi p = 0,00) Cu the, nhdm ngudi dudi 30 tudi cd miic dp iriim cam thap nhat (DTB = 4,66), dd, nhdm lir 40 den 50 luoi cd miic dp trSm cam cao nhat (DTB = 7,95) Nhom khaeh the tuoi tir 30 den 40 eo didm Irung binh ckc bieu hi^n tram cam cao hon mpt chiil so vdi nhdm khach the tren 50 tudi Cu the, cd d^n 14,3% so khaeh the tir 40 den 50 ludi cd bidu hien TAP CHi TAM LV H(X, Sd (214) -2017 55 trim cam vua vii nang; l').0°o sd khach thd lua tudi cd bieu hien tram cam nhe Nhdm khach thd^lua tudi tu 30 den 40 cd ty le ngudi mic tram cam vua \i nang dung thu hai (13.1% tren tijng khach thd lua tudi nay) Trong nhdm khich thd dudi 30 tudi chi cd 1.8% sd ngucri cd trim cam vua va nJng Cac khac bipt vd muc dp trim cam trpng cac nhdm khach thd d liia ludi khac cd >' nghta \a Uidng ke so sanh Anova vdi kdt qua F = 4,91 va p = 0.00 Ket qua thu dupc nghien cuu nax hoan loan phu hpp vdi kdt qua nghien ciiu tren the gidi \i anh hudng cua lira tudi ddn trim cam Cac nghien ciru eho thay ludi khdi phat cua benh ttim cam trai dai tu giai doan 10 den 65 tudi nhien lira tudi thudng gap trim cam nhidu nhit la 25 - 44 tudi Nghien cim cho lha\ cd khoang 24.0° o sd ngudi d lua tudi 48 bj trim cam nhttng ngudi tu 65 ludi trd Icn l\ lc trim cam chi khoang 10 - 15% Nhu vay Ida tudi tu 30 ddn 50 ed nguy co bj trim cam cao nhit bdi vi lua tudi la lua tudi dang sung sue dang tap trung vao lao ddng dd tich luy Lua ludi na\ cung cd eon dang tip tudi di hpc cd nhidu khd khan vd lam h' ctia tudi day thi \ a> cha mc ed nhicu ap lyc \ icc nudi da\' Bdng 2: Mdi ttrang quan giira tuoi va mirc dp lo du trdm cdm M i i c dn t r a m cam Dirol 30 tuoi T i r 30 den 40 luoi T i r 40 den 50 luoi T r e n 50 tuoi F SiR Dicm trung binh 4.66 6.76 7,95 6.67 4.91 0,00 Khong CO bieu hi^n 8' 56 TAPCHlTAMLyHOCSd (214), -2017 nghTa \e muc dp trim cam Nhtmg phu ntt a thj cd muc dp tram cam thap hon nhung ngudri d ndng thdn Thyc te cho thay ty le tram cam thudng tuong ddi cao d ngudi ngheo dan tdc thidu sd va nhung ngudi cd ngudn trp cap thip Nam 1978 Brpwn va Harris nghien cim 458 phu ntt d Nam London, da phat hien rang, lang Idp xa hdi la mpt yeu Id anh hudng den mue dp tram cam Nhttng phu ntt d tang Idp lao dpng cd hpan canh khd khan nhu ddng thidu ban be than thich khdng ed vide lam them cd kha nang bj tram cam cao hem nhdm phu nu d tang Idp trung binh \a hoan canh thuan Ipi hon Nhttng ngudi timg thieu \ e mat kinh te thudng trai qua nhicu sy kien lieu eye cudc sdng ban nhimg ngudi kinh te kha gia vi \'ay hp de bj tram cam hon (Brown G.W va Harris T.O 1978) Nhu va\ eongviec ctia phu ntt d ndng thdn thudng khdng tdt nhu phu ntt d thj (rong mau ehpn da sd phu ntt ndng thdn lam ndng nghi?p d nha lam edng nhan, phu ntt d thj deu lam can bd, nhan vien cdng ty cdng \icc dn djnh) Ihu nhap cua phu ntt d Ha Npi cap ban, dicu kicn kinh tc kha hon so vdi phu ntt d ndng thdn chinh \ i \ a> l> lc phu ntt d ndng thdn bj tram cam cao hon phu ntt n Ha Ndi !a dicu dc hicu Bdng 3: Ty li vd mirc dp trdm cdm & phu nir ndng thdn vd thdnh thi Nong Ihon Thanh Ihi Tong Chi binh phinmg Miie c6 y nghTa Khong tram cam 33.3% 30.9% 64.2% 10.95 0.00 Tram cam nhi; 18.5% 12.3% 30.9% iram cam vira va nang 4.9% 0,0% 4.9% Dicm trung binh mirc dg tram cam 6.29 4.18 T-test = 3.49 0,00 rf So sanh mirc trdm cdm giira nhirng phu nir chiu hao hdnh khdc bai chong ciia hg So sanh muc dp bj bao hanh d cae hinh Ihuc khac \ di muc dp tram cam d phu ntt kdt qua cho thay cd sy khae biet cd \' nghTa \ c mat thdng kc Cu the d nhdm phu nu khdng cd bieu hicn tram cam thi diem trung binh \c' tin suat \a hanh vi ciia cae dang bao hanh ma hp phai chju la rit thip (DIB bj bao hanh v e the chat = 0.29; linh than ^2.47; linh due = 0.67 va kidm soat = 0,51), dd dicm trung binh ve tan suat va hanh \ i cua cac dang bao hanh thd chai tinh than, linh due va kiem soat d nhdm phu ntt cd nguy ca trim cam lin lupt la 2.44, 4.84; 0.88 va 1,16, nhdm phu ntt ed trim cam nhe la 2,69; 6,92; TAP CHI TAM LV HOC, Sd (214), - 2017 57 ^3 va 11, d nhdm trim cam vua la 3,25; 7,62; 2,12 va 0,75 DSc b.?t nhom phu ntt ed muc dd tfim cam nJng cd diem trung binh muc dp bi b^o hanh rat cao cu thd DTB bao hanh Nd thd chat la 14.5: bao hanh ve tinh than \i 15,75; bao hanh vd tinh due la 1.75 va bao hanh dang kiem soat la 3,75 Ket qua nghien cuu trudng hpp didn hinh mdt lin ntta khang djnh bao hanh gia dinh la nguydn nhan gay trim cam d phu ntt Trudc ket hdn, ngudi phu nO khdng cp dau hieu ciia trim cam tuv nhien sau kdt hdn, bj ngudi chdng ludn mang chui, ndi chi la ngudi kem edl, ching bidt lam vice gi Chj ludn bi cang thang vi luc nap cung so minh lam sai va bj ming chui Ket qua la ch; bl tram cam nJng keo dai 10 nam Sau 1\ hdn khdng cdn bj nhiec mdc mang chui, ngum phy ntt da khdi ttim cam (Ca, phu ntt tri thuc 35 tudi Ha Npi) Nhidu nghien cuu vd anh hudng ciia bap hanh ddn van de stic khde tam diin da khing dinh bao hanh gia dinh la nguyen nhan gay tram cam (Andrews va Brown 1988; Astin va cpng sy,1993; Krug va cdng sy, 2002; Tang, 1997) Bao hanh gia dinh lam eho phu ntt m^c cam, ty ti giam sut ve mat sue khde, tinh thin, cam thiy bit lyc tdi te nen rit de din ddn tinh trang tram cam Ndi vd linh trang hdn nhan Herr va cpng sy cho ring, ca dan dng va phu ntt cd lich su trim cam ddu bao eao ring, hp it hai ldng vdi cupc hdn nhan cua hp ban nhttng ngudi khdng cd tidn su trim cam (Herr, Hammen va Brennan, 2007) va cac trieu ehung trim cam eua vp va chdng cd tuong quan thuan vdi muc dp xung dpi hdn nhan (Cummings va cpng sy, 2005) Nhu vay, cd thd kdt luan ring, tinh trang hanh phtic hdn nhan lit mpt ydu td quan trpng anh hudng ddn sue khde tinh than cua ngudi phu ntt, cy the la tinh tr?ng tram cam cua hp Bdng 5: Diim trung binh mirc dp bi bgo hdnh & phu nir cd mirc dd trdm cdm khdc Mire dQ bi bao hanh Mirc tram earn Tram Tram cam ciim nhe vihi Khong Iram cam Co nguy CO tram cam Tram cam nSng F Miircdp CO y nghla 0.29 2.44 2,69 3,25 14,50 9,13 0,00 Tinh thSn 2.47 4.84 6,92 7,62 15,75 15,82 0,00 Tinh due 0.6^ 0.88 2,23 2,12 1,75 4,60 0,00 Kicm soat 0,51 1.16 1.11 0,75 3,75 8,09 0,00 'ni 58 chSt TAP CHI TAM LV HOC, S6' ( ) , - 2017 / Khdc biel vi mirc da IrSm cdm Iheo thai gian kei hon ctia phii nir So sanh khac biet gitta thdi gian kdt hdn vdi muc dp tram cam ket qua phan tich Anova cho thiy cd sy khac biet ve muc dp tram cam gitta nhttng phu ntt cd thdi gian kdt hdn khac (F = 6.34 vdi p = 0.00) Nhttng phu ntt cd thdi gian ket hdn ngin nhit dudi nam ed mue dp tram cam thap nhat (DIB = 4.57), sau dd den nhirng phu nu kdt hdn lu 11 den 20 nam (DTB = 5.35) muc dp tram cam cap nhat la nhdm phu ntt ket hdn tu den 10 nam \ a nhdm ket hdn tren 20 nam Tu ket qua cd the khang djnh rang, cupc sdng hdn nhan la mdt tac nhan gay tram cam eho phu ntt Ihdi gian ket hdn cang dai ddng nghia vdi vice cd nhieu sy kien xay eupc sdng gia dinh (cpn ddi cang thing vi viec nudi day lo lang cho vice hpc hanh cua rdi dyng vp ga chdng cho con) cang cd nhicu tinh hudng sinh mau thuan vi cha me phai giai quyel nhicu vice gia dinh, eang cd nhieu kha nang gay cang thang cho ngudi phu ntt Nhdm phu ntt mdi ket hdn, chua cd con, cudc sdng hdn nhan mdi bat dau ehua cd mau thuan sinh vi vay mue dp tram cam it nhat la dc hieu Nhdm phu ntt da kcl hdn dupc den 10 nam la nhdm cd dp tudi an hpc va cha me can danh nhieu thdi gian cho con, kinh le gia dinh chua dupc dn djnh, phu ntt d lira tudi cd nhicu mdi ban tam Chinh \i \ay ma muc dp tram cam d nhdm phu ntt eao nhat Nhdm phu ntt kcl hdn Itt 11 den 20 nam la nhdm da dn djnh \c kinh tc va vc nen it ap lye cudc sdng hem Nhdm phu ntt cd Ircn 20 nam hdn nhan cung la nhdm phu ntt ldn ludi \ a thudng roi vao thdi ky tien man kinh day la thdi k\ khd khan cua phu ntt \a\ nguy ep bj tram cam cung tang cao Bdng 6: So sanh mirc dp trdm cdm & cdc nhdm phu nir cd thai gian kit hdn khdc Thin gian kei hon Mirc dp tram cam(Dn)) nam 2-5 nam - nam It-20 nam Tren 20 nam F Mu-c CO y nghla 4.57 6.00 10.08 5.35 7.51 6.34 0.00 Ket luan Phu ntt Viel Nam cd ty lc tram cam d ngudng trung binh so vdi phu nu Iren thd gidi NhOng ngudi sdng d ndng thdn cd nguy co bj tram cam cao hem nhttng ngudi sdng d Ihanh phd Phu ntt dp tudi itt 30 den 50 cd muc dp trim cam cao hon so \di phu ntt dudi 30 tudi va tren 50 ludi Nhttng phu ntt bj bao hanh cd nguN ca bi tram cam cao hon nhttng phu ntt khdng bj bao hanh ITidi gian kcl hdn cang dai thi muc dp tram cam cang cao TAP CHi TAM Lf HOC S (214) - 2017 59 Tai lieu tham khao NiziiMln \'ati Siem \)>hii}n ciru dich te lain sdng cdc rin hujn train cam lgi nnit sii qudn the va t ()//>,' t/ii//^' D^ tai nhanh ciia Chirtmg trinh Ni!lui;n ciru khoa hpc cap \ h a nudc ma so KII 11-01 1999-2000 Ni;ii\cn Kim Viet, \fot so lien hg mdi irong dieu tri iriiin cam Hoi thao chujcn dc Tram cam Vi?n Sire khoe Tam than - Bo mon Tam than - Dai hpc Y I la Noi 2006 BrowTi G W and Harris T.O Social Origins of Impression:.-/ sluc/y of psychiatric disonler in women, London la\Lsiock 1978 Cummings M Keller P.S, and Davies P.T., Towards a family process model of niatenial ami paternal depressive symptoms Hxploring miilliple relations with child andfainilv ftinclion Journal of Child PsychoIog\ and Psychiatry 46 (5) pp 479 > 489 2005 Herr N.R., Hammen C and Brennan P A Current and past depression as preiliclors of faniiiv funclioning .1 comparison of men and women in a communitv sample Journal of i-amil> i\\cholog> 21 (4) pp 694 - 702 2007 Iliroto l)onaldS., Seligman Martin I- (/t'/;t'm///i(;//mr/)«//;LV/j/t*v.ww.w- Jounial of Pcn«)nallil> and Social Psjchology Vol 31 Is.suc Dated (1975) pp 11 -327 l-rankcl \ :i cgng sir, Relmions among Depression, ['amily Context and Gender in Offspring of Depres.scd and \on-l)c|iri.ssCLl Parents, 2010 Nolen-Hoeksema et all Explaining ihe Gender Difference in Depressive Svmptoms Journal of Personalhty and Social Psychology Voi 77 No 5, pp 1.061 - I 072, 1999 Park I.J.K Garber J Ciesia J A and Ellis BJ., Convergence among muhiple methods of mea.surmg posilivity and negatmly m the family environment: Relation lo depres.sion in mothers (W//;t';rt7?//(/rt'n, Journal of i-amiiy Psychoiogv 22 (1), pp 123 - 134, 2008 10 Iang C.S., Psychological ahn.se of Chinese Wives Journal of Family Violence Vol 13 No 1998 I \MIO Children and adolescent Disorders, Management of Mental Disorders Vol pp 516-537, 2000 ^ TAPCHfTAMLVHOCSdl (214), I -2017 ... Thin gian kei hon Mirc dp tram cam(Dn)) nam 2-5 nam - nam It-20 nam Tren 20 nam F Mu-c CO y nghla 4.57 6.00 10.08 5.35 7.51 6.34 0.00 Ket luan Phu ntt Viel Nam cd ty lc tram cam d ngudng trung binh... cam cao hon gap lan nam gidi bdi vai tro cua phu nu gia dinh 'a xa hpi khac biel vdi nam gidi phu nii ehiu nhieu ap tuc hon nam gidi phai ganh vac nhicu traeh nhiem hon nam gidi gia dinh nhung... ap luc cupc song gia dinh hon nam gidi nhai la d Vict Nam noi van nhieu dinh kicn c gidi Day co the la nuucn nhan dan den vice phu nir co t lc tram cam cao ban nam gidi Tram cam ciing la benh