抑郁症和双相障碍患者服药依从性及相关因素分析的多中心横断面研究

Medication adherence and related factors in patients with major depressive disorder or bipolar disorder:A multicenter cross-sectional study

目的 对门诊抑郁症/双相障碍患者的服药依从性现状进行调查,探索服药依从性的影响因素.方法 采用多中心连续入组的方法,选取首都医科大学附属北京安定医院、南京脑科医院、昆明医学院附属第一医院、广州市精神病医院、哈尔滨医科大学附属第一医院、第四军医大学附属西京医院等6家三级甲等精神专科医院或综合医院精神科为研究中心,对2015年10月至2016年3月就诊于各中心的门诊抑郁症/双相障碍患者进行访谈,对服药依从性和相关因素等主要观察指标进行统计分析.结果 共收集有效资料1206份,其中758例(62.85%)服药依从性较差;双相/抑郁患者中依从性差分别为56.49%(296/524)和67.74%(462/682).服药依从性好与差的两组患者在年龄、教育程度、疾病诊断、2年内发作次数、本次发作病程、抑郁严重程度、自知力、就诊医院类型等方面差异有统计学意义(P<0.05).多因素分析显示,本科以下学历患者(OR=0.719,95%CI:0.542~0.953,P<0.05)、2年内发作2次以上的患者(OR=0.424,95%CI:0.251~0.716,P<0.01)及中重度抑郁发作的患者(OR=0.444,95%CI:0.327~0.603,P<0.01)服药不依从风险较低;于综合医院就诊的患者不依从风险低于精神专科就诊患者(OR=0.328,95%CI:0.241~0.447,P<0.01);抑郁症患者服药不依从的风险高于双相障碍患者(OR=1.659,95%CI:1.205~2.284,P<0.01).结论 抑郁症和双相障碍门诊患者服药依从性不佳,相关因素包括疾病种类、当前发作的严重程度、既往发作次数、就诊医院类型、教育程度等,有必要采取措施提升抑郁症和双相障碍患者对药物治疗的依从性.

Objective To investigate the current situation of medication adherence of outpatients with depression/bipolar disorder,and explore the influencing factors of medication adherence.Methods A total of six 3A psychiatric hospitals or general hospitals,including Beijing Anding Hospital Affiliated to Capital Medical University,Nanjing Brain Hospital,the First Affiliated Hospital of Kunming Medical College,Guangzhou Psychiatric Hospital,the First Affiliated Hospital of Harbin Medical University and Xijing Hospital Affiliated to the Fourth Military Medical University,were selected as research centers by multicenter continuous enrollment.From October 2015 to March 2016,the outpatients with depression/bipolar disorder from every center were interviewed,and the medication compliance and related factors were statistically analyzed.Results A total of 1206 valid data were collected,of which 758 cases(62.85%)had poor medication compliance,and the proportion of bipolar disorder and depression was 56.49%(296/524)and 67.74%(462/682)respectively.The differences between the two groups in age,education level,disease diagnosis,the number of attacks within 2 years,the course of the attack,the severity of depression,insight,and the type of hospital were statistically significant(P<0.05).Multivariate analysis showed that the risk of non-compliance was lower in patients with bachelor degree or below(OR=0.719,95%CI:0.542-0.953,P<0.05);the risk of non-compliance was lower in patients with 2 episodes with last 2 years(OR=0.424,95%CI:0.251-0.716,P<0.01);the risk of non-compliance was lower in patients with moderate to severe depression(OR=0.444,95%CI:0.327-0.603,P<0.01);the risk of non-compliance was lower in general hospital patients than in psychiatric hospital patients(OR=0.328,95%CI:0.241-0.447,P<0.01);the risk of non-compliance was higher in depression patients than in bipolar disorder patients(OR=1.659,95%CI:1.205-2.284,P<0.01).Conclusions The medication adherence of outpatients with major depressive disorder or bipolar disorder is not optimistic.The related factors include the type of disease,the severity of the current attack,the number of previous attacks,the type of hospital,and the level of education.It is necessary to take measures to improve the medication adherence of patients with depression and bipolar disorder.