臨床治愈后抑郁癥患者心理社會功能的對比研究
發(fā)布時(shí)間：2018-08-16 15:57
【摘要】：抑郁癥(Major Depressive Disorder,MDD)是一種高發(fā)病率、高致殘率、高復(fù)發(fā)率的慢性精神障礙,抑郁癥急性期治療的主要目標(biāo)是臨床治愈(remission),其操作定義為漢密爾頓抑郁量表17項(xiàng)版本(Hamilton Depression Scale,HAMD-17)≤7分,即臨床癥狀的嚴(yán)重程度不再符合各種診斷體系所需的標(biāo)準(zhǔn)。大量研究發(fā)現(xiàn)心理社會功能的恢復(fù)在臨床治愈中也占據(jù)重要地位,當(dāng)HAMD-17≤7分時(shí),患者的心理社會功能還未完全恢復(fù)。但目前關(guān)于臨床治愈后抑郁癥患者心理社會功能的研究大都采用橫向?qū)Ρ确椒?僅分析了臨床治愈時(shí)患者心理社會功能的差異,而極少有研究采用縱向追蹤設(shè)計(jì)對此進(jìn)行驗(yàn)證。本研究通過縱向追蹤設(shè)計(jì),對167名達(dá)到臨床治愈標(biāo)準(zhǔn)的抑郁癥患者以臨床治愈時(shí)的貝克抑郁自評量表(Beck Depression Inventory,BDI)得分進(jìn)行分組:低分組(BDI≤4分)和高分組(BDI≥4分),并采用生活質(zhì)量綜合評定問卷(Generic Quality of Life Inventory,GQOLI-74)對高低分組患者的心理社會功能進(jìn)行為期一年的隨訪研究。本研究旨在:①考察高低分組患者在達(dá)到臨床治愈后一年內(nèi)的復(fù)發(fā)情況;②了解達(dá)到臨床治愈后,高低分組患者心理社會功能恢復(fù)的差異;③探究在康復(fù)過程中,社會支持、自動思維對抑郁癥患者心理社會功能恢復(fù)的影響。通過SPSS19.0進(jìn)行描述性分析、生存分析、t檢驗(yàn)、χ2檢驗(yàn)、重復(fù)測量方差分析、相關(guān)分析以及多元回歸分析,所得結(jié)論如下:(1)經(jīng)急性期治療達(dá)到臨床治愈后,BDI高分組患者一年內(nèi)的復(fù)發(fā)率(27.8%)比低分組患者(22.2%)高,但未達(dá)到顯著差異(χ2=0.62, p=0.430.05)。(2)經(jīng)急性期治療達(dá)到臨床治愈后,BDI高低分組患者心理社會功能存在差異:基線期時(shí),高分組患者心理社會功能水平比低分組患者低。隨后,高分組患者心理社會功能水平快速提高,兩個(gè)月時(shí)兩組心理社會功能的差異消失,但高分組心理社會功能的整體水平仍低于低分組。從心理社會功能的變化趨勢看,低分組變化平穩(wěn),總體呈現(xiàn)上升趨勢;高分組變化明顯,呈現(xiàn)“先急后緩”的趨勢,且在九個(gè)月時(shí)軀體功能和心理功能呈現(xiàn)下降趨勢。由此可知,臨床治愈后抑郁癥患者心理社會功能未恢復(fù)到正常水平且其后的恢復(fù)過程也未達(dá)到理想狀態(tài),可證實(shí)抑郁癥臨床治愈標(biāo)準(zhǔn)(HAMD-17≤7分)有效性和全面性都存在不足。(3)與HAMD-17總分相比,BDI總分更能反應(yīng)抑郁癥患者的心理社會功能水平及變化,即抑郁癥患者對疾病癥狀的自我感受與其心理社會功能的變化更一致,臨床上對于抑郁癥患者的評估同時(shí)需要關(guān)注患者自我的內(nèi)在感受。(4)臨床治愈后一年內(nèi),癥狀嚴(yán)重程度始終對抑郁癥患者的心理社會功能具有顯著負(fù)向預(yù)測作用;自動思維在臨床治愈后初期對心理社會功能的有顯著的負(fù)向預(yù)測作用;客觀支持、主觀支持在臨床治愈初期對患者的心理社會功能有顯著正向預(yù)測作用,而支持的利用度在臨床治愈后兩個(gè)月時(shí)才開始顯現(xiàn)作用,但隨時(shí)間發(fā)展其作用重要性愈加凸顯。
[Abstract]:Major Depressive Disorder (MDD) is a chronic psychiatric disorder with high morbidity, disability and recurrence rate. The main goal of treatment in acute stage of depression is remission. The operation is defined as Hamilton Depression Scale (HAMD-17) > 7, that is, the severity of clinical symptoms. A large number of studies have found that the recovery of psychosocial function plays an important role in the clinical cure. When the score of HAMD-17 is less than 7, the psychosocial function of the patients has not been fully restored. However, most of the current studies on psychosocial function of the patients with post-clinical depression are based on cross-sectional comparison. Methods: The difference of psychosocial function in patients with clinical cure was analyzed only, and few studies validated it by longitudinal follow-up design. In this study, 167 depressive patients who met the clinical cure criteria were scored with Beck Depression Inventory (BDI) at the time of clinical cure. Groups were divided into two groups: low score group (BDI < 4) and high score group (BDI < 4). A one-year follow-up study was conducted with the Generic Quality of Life Inventory (GQOLI-74). The aim of this study was to investigate the recovery of high and low score patients within one year after clinical cure. (2) Understanding the difference of psychosocial function recovery between high and low groups after clinical cure; and (3) Exploring the effect of social support and automatic thinking on the recovery of psychosocial function in patients with depression during rehabilitation. The results were as follows: (1) The recurrence rate of high BDI group was higher than that of low BDI group in one year (27.8%) after clinical cure, but the difference was not significant (2 = 0.62, P = 0.430.05). (2) After clinical cure, the psychological and social function of high and low BDI group patients survived. Differences: At baseline, the psychosocial function level of the high-grouping patients was lower than that of the low-grouping patients. Subsequently, the psychosocial function level of the high-grouping patients increased rapidly and disappeared at two months, but the overall level of psychosocial function of the high-grouping patients was still lower than that of the low-grouping patients. The change of low-grade group was stable and showed an upward trend in general; the change of high-grade group was obvious, showing a "first urgent and then slow" trend, and the physical and psychological functions showed a downward trend at nine months. It can be seen that the psychosocial function of the patients with depression after clinical cure did not return to normal level and the recovery process did not reach the ideal state. (3) Compared with the total score of HAMD-17, the total score of BDI can better reflect the level and change of psychosocial function of depressive patients, that is, the self-feeling of depressive patients to the symptoms of the disease is more consistent with the change of psychosocial function. The assessment of depressive patients also needs to pay attention to the inner feelings of the patients themselves. (4) Within one year after clinical cure, the severity of symptoms has a significant negative predictive effect on the psychosocial function of depressive patients; automatic thinking has a significant negative predictive effect on the psychosocial function in the early stage after clinical cure; objective support, subjective support Observational support has a significant positive predictive effect on the psychosocial function of patients in the early stage of clinical cure, and the utilization of support begins to show effect only two months after clinical cure, but its role becomes more and more important with the development of time.
【學(xué)位授予單位】：南京師范大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：B842
本文編號：2186461
[Abstract]:Major Depressive Disorder (MDD) is a chronic psychiatric disorder with high morbidity, disability and recurrence rate. The main goal of treatment in acute stage of depression is remission. The operation is defined as Hamilton Depression Scale (HAMD-17) > 7, that is, the severity of clinical symptoms. A large number of studies have found that the recovery of psychosocial function plays an important role in the clinical cure. When the score of HAMD-17 is less than 7, the psychosocial function of the patients has not been fully restored. However, most of the current studies on psychosocial function of the patients with post-clinical depression are based on cross-sectional comparison. Methods: The difference of psychosocial function in patients with clinical cure was analyzed only, and few studies validated it by longitudinal follow-up design. In this study, 167 depressive patients who met the clinical cure criteria were scored with Beck Depression Inventory (BDI) at the time of clinical cure. Groups were divided into two groups: low score group (BDI < 4) and high score group (BDI < 4). A one-year follow-up study was conducted with the Generic Quality of Life Inventory (GQOLI-74). The aim of this study was to investigate the recovery of high and low score patients within one year after clinical cure. (2) Understanding the difference of psychosocial function recovery between high and low groups after clinical cure; and (3) Exploring the effect of social support and automatic thinking on the recovery of psychosocial function in patients with depression during rehabilitation. The results were as follows: (1) The recurrence rate of high BDI group was higher than that of low BDI group in one year (27.8%) after clinical cure, but the difference was not significant (2 = 0.62, P = 0.430.05). (2) After clinical cure, the psychological and social function of high and low BDI group patients survived. Differences: At baseline, the psychosocial function level of the high-grouping patients was lower than that of the low-grouping patients. Subsequently, the psychosocial function level of the high-grouping patients increased rapidly and disappeared at two months, but the overall level of psychosocial function of the high-grouping patients was still lower than that of the low-grouping patients. The change of low-grade group was stable and showed an upward trend in general; the change of high-grade group was obvious, showing a "first urgent and then slow" trend, and the physical and psychological functions showed a downward trend at nine months. It can be seen that the psychosocial function of the patients with depression after clinical cure did not return to normal level and the recovery process did not reach the ideal state. (3) Compared with the total score of HAMD-17, the total score of BDI can better reflect the level and change of psychosocial function of depressive patients, that is, the self-feeling of depressive patients to the symptoms of the disease is more consistent with the change of psychosocial function. The assessment of depressive patients also needs to pay attention to the inner feelings of the patients themselves. (4) Within one year after clinical cure, the severity of symptoms has a significant negative predictive effect on the psychosocial function of depressive patients; automatic thinking has a significant negative predictive effect on the psychosocial function in the early stage after clinical cure; objective support, subjective support Observational support has a significant positive predictive effect on the psychosocial function of patients in the early stage of clinical cure, and the utilization of support begins to show effect only two months after clinical cure, but its role becomes more and more important with the development of time.
【學(xué)位授予單位】：南京師范大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：B842
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