临床治愈后抑郁症患者心理社会功能的对比研究
发布时间：2018-08-16 15:57
【摘要】：抑郁症(Major Depressive Disorder,MDD)是一种高发病率、高致残率、高复发率的慢性精神障碍,抑郁症急性期治疗的主要目标是临床治愈(remission),其操作定义为汉密尔顿抑郁量表17项版本(Hamilton Depression Scale,HAMD-17)≤7分,即临床症状的严重程度不再符合各种诊断体系所需的标准。大量研究发现心理社会功能的恢复在临床治愈中也占据重要地位,当HAMD-17≤7分时,患者的心理社会功能还未完全恢复。但目前关于临床治愈后抑郁症患者心理社会功能的研究大都采用横向对比方法,仅分析了临床治愈时患者心理社会功能的差异,而极少有研究采用纵向追踪设计对此进行验证。本研究通过纵向追踪设计,对167名达到临床治愈标准的抑郁症患者以临床治愈时的贝克抑郁自评量表(Beck Depression Inventory,BDI)得分进行分组:低分组(BDI≤4分)和高分组(BDI≥4分),并采用生活质量综合评定问卷(Generic Quality of Life Inventory,GQOLI-74)对高低分组患者的心理社会功能进行为期一年的随访研究。本研究旨在:①考察高低分组患者在达到临床治愈后一年内的复发情况;②了解达到临床治愈后,高低分组患者心理社会功能恢复的差异;③探究在康复过程中,社会支持、自动思维对抑郁症患者心理社会功能恢复的影响。通过SPSS19.0进行描述性分析、生存分析、t检验、χ2检验、重复测量方差分析、相关分析以及多元回归分析,所得结论如下:(1)经急性期治疗达到临床治愈后,BDI高分组患者一年内的复发率(27.8%)比低分组患者(22.2%)高,但未达到显著差异(χ2=0.62, p=0.430.05)。(2)经急性期治疗达到临床治愈后,BDI高低分组患者心理社会功能存在差异:基线期时,高分组患者心理社会功能水平比低分组患者低。随后,高分组患者心理社会功能水平快速提高,两个月时两组心理社会功能的差异消失,但高分组心理社会功能的整体水平仍低于低分组。从心理社会功能的变化趋势看,低分组变化平稳,总体呈现上升趋势;高分组变化明显,呈现“先急后缓”的趋势,且在九个月时躯体功能和心理功能呈现下降趋势。由此可知,临床治愈后抑郁症患者心理社会功能未恢复到正常水平且其后的恢复过程也未达到理想状态,可证实抑郁症临床治愈标准(HAMD-17≤7分)有效性和全面性都存在不足。(3)与HAMD-17总分相比,BDI总分更能反应抑郁症患者的心理社会功能水平及变化,即抑郁症患者对疾病症状的自我感受与其心理社会功能的变化更一致,临床上对于抑郁症患者的评估同时需要关注患者自我的内在感受。(4)临床治愈后一年内,症状严重程度始终对抑郁症患者的心理社会功能具有显著负向预测作用;自动思维在临床治愈后初期对心理社会功能的有显著的负向预测作用;客观支持、主观支持在临床治愈初期对患者的心理社会功能有显著正向预测作用,而支持的利用度在临床治愈后两个月时才开始显现作用,但随时间发展其作用重要性愈加凸显。
[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.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B842
本文编号：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.
【学位授予单位】：南京师范大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：B842
【参考文献】
相关期刊论文 前10条
1 马莎;张旭;李竺君;崔海松;刘美兰;吴文源;赵旭东;;首发与复发抑郁症患者社会功能状况及影响因素分析[J];临床精神医学杂志;2016年01期
2 陈金宝;邱李斌;王北琪;曾洁;陈征;;固定点处组间生存率比较的统计检验法[J];中华流行病学杂志;2015年02期
3 曹瑞想;马辉;杨华;杨娟;罗厚员;曲海涛;张宁;;抑郁症临床治愈的指标及其有效性研究[J];中华精神科杂志;2014年04期
4 赵靖平;;抑郁症的临床治愈[J];中华精神科杂志;2013年04期
5 张明园;;抑郁症临床治愈和用药实践问题的提出[J];中华精神科杂志;2013年04期
6 马辉;杨华;张宁;;抑郁症康复期心理社会功能恢复特点及持续心理治疗的必要性[J];中华行为医学与脑科学杂志;2011年12期
7 张宁;;临床痊愈为抑郁症的治疗目标[J];中华精神科杂志;2011年01期
8 王雁飞;社会支持与身心健康关系研究述评[J];心理科学;2004年05期
9 张迎黎,李鹤展;社会支持与抑郁症的相关性分析[J];中国临床康复;2003年30期
10 管新丽;抑郁症病人的社会支持状况及护理干预[J];护理研究;2003年15期
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