Trầm cảm ở phụ nữ việt nam

TRAM C A M 6 PHU NQ VIET NAM
Nghidn cihi nay 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 ra nhieu
Idn hai vi sire khoe vd ldi ehinh nhdl trong 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 nhau dua ra cdc ly le trdm cdm khdc nhau. 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 5 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 5 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 1 (214), 1 - 2017


Ly do nghien ciru
Tram cam (depression) la mot trong nhimg roi loan tam than pho bien nhat
trong cae loai benh \ c sire khoe lam than. Tram cam con 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 2
lan (1)SM-1\'|. Co nhieu nguyen nhan dan den Iram cam. mdt trong nhirng ngu>en
nhan \e mat xa hpi la do ap lue cudc song. Phu nir thudng chju nhicu ap luc
trong cupc song gia dinh hon nam gidi. nhai la d Vict Nam. noi van con 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) ra nhicu ton hai \c kinh te \a
la benh ga\ ra ihucmg tat Urn nhat trong cac loai benh tat eiia eon ngudi. I y le
ngudi tu sat do tram cam nga> cang tang cao tren the gidi. chiem 46.0% so ngudi tu
sal (Bourgeois, 1998).

O Vict Nam. trong 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 ra 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 nhau. Cac nghien ciiu ve
dich tc hoc cung da dua ra con so thong kc khae nhau 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 khi tac gia La Thi Budi phat hien ra
CO 4.l*'.o ngudi mac benh tram cam d mot phudng trong mpt thanh pho 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
ra 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 nay nham tim hicu tram cam d phu nii d eac viing mien khac nhau
trong 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 ra cac khai niem cung nhu bieu hicn khac nhau eiia
tram cam. Tuy nhien, trong nghien cim na). ehiing toi six dung khai niem tram cam
cua Hiep hpi Tam ly hpc Hoa K\. Iheo do. 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' 1 (214), 1 -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 hung thit
tham gia eac boat ddng mang lai nidm \aii, mit cam giac ngon mieng hoac an qua
nhidu. gap khd khan trong 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 ra trim cam la khac nhau. Ndi bat la cac hudng tiep can tir gde do
sinh hpc. mdi trucmg sdng. nhan thire va hanh vi.
- Cae nghien cira tram cam tu gde do sinh hpc tap trung vao nghien ciru
thuc trang tram cam cua eac thanh \ien trong gia dinh. cac cSp song sinh. nghien
cuu mdi quan he gitta tram cam cua cha mc rupl vdi nhttng dira con da cho lam
con nudi trong cac gia dinh khac. nghien eiru eo che sinh hda, nghien cim > eu td
van hda xa hdi... dc tim ra mdi quan he gitta gen di truyen va tram cam... Cac
ket qua nghien cuu tram cam cua thanh vien trong gia dinh cho thay, gen di
truyen cd kha nang la tac nhan gay ra 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 2 den 3 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 con. Cac nha nghien cuu cac cap song sinh khing djnh ring, trim cam la do
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 nhau
nen khd khang djnh tram cam do mdi trudng huy do gen. Chinh vi vay, nhttng
nghien cuu ve con nudi giitp giai quydt didm yeu nay. Nhttng nghidn cira con

nudi da so sanh nhQng ngudi dupe nhan nudi khi 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 trong
mdt mdi trudng hoan loan khac (ydu Id trim cam phat sinh do mdi trudng dupc
loai bd) nhung van cd mdi tuong quan thuan gitta mue dp trim cam d nhttng
ngudi dupe eho lam con nudi va bd me rupt cua hp (Wendcr va cpng s\f, 1986).
Phan Idn cae nghien eira ehi ra ring, nhttng dua Ire con nudi bi trim cam cd
Chan doan tuong tu nhu anh cm rudt nhidu hon anh cm nudi 20% so vdi 5 - 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 ra gia ihuycl rang
qua nhicu chat noradrenaline gay ra hung cam. trong khi qua it chat do ga\ ra
Uam cam. Nghien cim sau do 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 nay \ c cae nhom phu nii
CO hoan eanh kinh le xa hpi khac nhau cho thay. cac nhdm phu nii do ed miic dp
tram cam khac nhau. Cac nghien ciiu \e gidi tinh cho thay. phu nii co t\ !e tram
cam cao hon gap 2 lan nam gidi bdi vai tro cua phu nu trong gia dinh \'a xa hpi
khac biel vdi nam gidi. phu nii ehiu nhieu ap tuc hon nam gidi khi phai ganh vac
nhicu traeh nhiem hon nam gidi trong 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 ra 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 nhau ihco gidi tinh ciia cha me va eon. Dae biet. mdi quan he giira eac
trieu chiing tram cam ciia cha me \ a cac thanh to nhat dinh ciia bdi canh gia dinh
manh hon doi vdi con gai so vdi con Uai. trong khi mdi tuong quan giiia cac
thanh to boi canh gia dinh va cac trieu chirng iram cam cua eon manh hon doi
vdi me trong so sanh vdi cha.
- Nguyen nhan Uain cam con 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 do 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 ra khoi nhiing dicu kicn kho khan.
\'hd!i ihirc lieu cue la mpt trong 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 con ngudi. Con ngudi cd nhung loi trong
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 nay 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), 1 -2017

53


thd nghien cuu la 30,06. trong 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 trong ndi Ihanh (cu dan do 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 nay. chitng tdi dung thang do Tram cam PHQ-9. Thang
do 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" do 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 khi dung cho ngudi Viet Nam. Bang PHQ-9 gdm 9 cau hdi ve 4
mat nhan thuc, cam xuc, hanh vi. sinh ly.
Nhihig uieu chung phai keo dai il nhat trong 2 tuan. Mdi cau tra ldi dupc
gan cho gia trj tu 0 - 3, theo muc dp tang dan: (0) khdng ngay nap, (I) vai ngay
( 1 - 7 nga)). (2) hon mdt nua sd ngay ttong hai tuan ( 8 - 1 1 ngay). (3) gan nhu
mpi ngay (12- 14 ngay). Trong nghien cim nay, he sd Alpha eua Cronbach ciia
thang do 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 1 ddn 9. tdng diem cao nhat se la
27. Viec phan loai theo ldng didm dupc tinh nhu sau:
^ Dicm 0 - 4 : Khdng tram cam;
+ Diem 5 - 9 : 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 ra d bang 1 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% trong tdng sd phu ntt dupc nghien ciru. Nhu vay. ty Id phu nu
trong 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 5 den 9°'o sd phu ntt \1> bj trim cam vua va nang, trong khi nam gidi My bj
tram cam ehi chiem tu 2 den 3% eho thiy. kdt qua nghien cira nay la phu hpp
vdi tinh hinh chung tren thd gidi, luy nhien nim d ngu<>ng thip.

TAP C H I T A M L f HOC, 86' 1 (214), 1 -

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. khi so sanh ket qua nghien
cuu nay 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 trong nghien ciru cua chiing
tdi bi tram cam cao han ty le ngudi bi tram cam d khu vuc thanh thj (2.8%
trong 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% trong nghien cuu ctia Ngd Ngpc Tan.
Cao Tien Due (2001) va La Thj Budi a vung thanh 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 con sd khac nhau nay cd the la do mau cua
ehung tdi la phu ntt, vi vay se eao ban khi so vdi cac mau chung d vung thanh
thj hay cac vimg kinh te xa hdi khac nhau. luy nhien, mau nay cd dai dien ca
ndng thdn lan thanh 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 do 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 nhau
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 trong dp tuoi 12 - 17 la 5,7% nhung den dp ludi 40 - 59 ty

le nay 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 khi cac con so trong bang 2 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), trong khi 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 1 (214). 1 -2017

55


trim cam vua vii nang; l').0°o sd khach thd lua tudi nay 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 nhau cd >' nghta
\a Uidng ke khi so sanh Anova vdi kdt qua F = 4,91 va p = 0.00. Ket qua thu
dupc trong 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. tuy 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 trong khi 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 nay 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. do \ a>. cha mc ed nhicu
ap lyc trong \ icc nudi da\' con.
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<).:%

73.7%

66,7%

73.3%

Tram cam nh?

9.0%

13.2%

19,0%

20,0%

Tram cam vira

va n$ng

I.X°.

13,1%

14.3%

6.7%

c. So sanh mice dp Iram cdm giira phu nd' & nong Ihon va do thj
Theo cac ket qua nghien cuu cua cac tac gia khac nhau it Vi?t Nam khi
nghien cuu d eac khu vuc khac nhau thi thiy cd sy khac bidt vd ly Id ngudi bj
tram cam d cac khu vuc ndng thdn va dd thj. Nhdm khach thd p khu vyc ndng
thdn cd ly lc tram cam cao hon gip hai lin so vdi nhdm khach thd d dd thj
(8.35°b so viVi 3.4% va 4.1% theo nghidn cuu cita Nguydn Van Siem. Ngd Ngpc
Tan va I.a I'hj Budi). Kcl qua nghien cuu eua chimg tdi cung phii hirp vdi eac
kcl qua trdn. gitta phu ntt d ndng thdn va thanh phd eung ed su khac bipt cd >'

56

TAPCHlTAMLyHOCSd 1 (214), 1 -2017


nghTa \e muc dp trim cam. Nhtmg phu ntt a thanh 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 con.

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 trong
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 thanh thj (rong mau ehpn. da sd phu ntt ndng
thdn lam ndng nghi?p. d nha. lam edng nhan, trong khi phu ntt d thanh 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 do
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 do trdm cdm giira nhirng phu nir chiu hao hdnh khdc
nhau bai chong ciia hg
So sanh muc dp bj bao hanh d cae hinh Ihuc khac nhau \ 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 hung 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),
trong khi 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 1 (214), 1 - 2017

57


7 ^3 va 1 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 ra trim cam d phu ntt. Trudc khi ket hdn, ngudi phu nO khdng cp dau
hieu ciia trim cam. tuv nhien sau khi 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 khi 1\ hdn. khdng cdn bj nhiec mdc. mang chui, ngum phy

ntt nay 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 ra 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 trong 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 nhau

Mire dQ bi
bao hanh

Mirc do 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' 1 ( 2 1 4 ) , 1 - 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 nhau (F = 6.34 vdi p = 0.00). Nhttng phu ntt cd thdi
gian ket hdn ngin nhit. dudi 1 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 5 den 10 nam \ a nhdm ket hdn tren 20
nam. Tu ket qua nay 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 ra trong eupc sdng gia dinh (cpn ra ddi. cang thing vi viec
nudi day con. lo lang cho vice hpc hanh cua con. rdi dyng vp ga chdng cho con)
cang cd nhicu tinh hudng nay sinh mau thuan vi cha me phai giai quyel nhicu
vice trong 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 nay sinh. vi vay mue dp tram cam it nhat la dc hieu. Nhdm phu ntt
da kcl hdn dupc 5 den 10 nam la nhdm cd con trong dp tudi an hpc va cha me
can danh nhieu thdi gian cho con, trong khi kinh le gia dinh chua dupc dn djnh,
phu ntt d lira tudi nay cd nhicu mdi ban tam. Chinh \i \ay ma muc dp tram cam
d nhdm phu ntt nay eao nhat. Nhdm phu ntt kcl hdn Itt 11 den 20 nam la nhdm
da dn djnh \c kinh tc va vc con 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. do \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 nhau
Thin gian
kei hon
Mirc dp tram
cam(Dn))

1 nam

2-5

nam

5 - 1 0 nam

It-20
nam

Tren 20
nam

F

.Mu-c do 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 trong 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 6 1 (214). 1 - 2017

59


Tai lieu tham khao
1 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.
2 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.
3. BrowTi G W. and Harris T.O.. Social Origins of Impression:.-/ sluc/y of psychiatric disonler in
women, London la\Lsiock. 1978.
4. Cummings 1. 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.
5. 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.
6. 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 2. Dated (1975). pp. 3 11 -327.
7. 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.

8. 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.
9. 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
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pp. 516-537, 2000.

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TAPCHfTAMLVHOCSdl (214), I -2017