抑郁症患者服药依从性的影响因素

Influencing factors of medication adherence in patients with depression

目的探讨抑郁症患者服药依从性的影响因素。方法选取2016年11月至2019年10月就诊于首都医科大学附属北京安定医院门诊的158例抑郁症患者,在研究结束后(时间均值为1年)对患者进行电话访视,采用药物依从性评定量表(MARS)总分将其分为服药依从性好组(MARS总分≥6分)和服药依从性差组(MARS总分<6分)。分析比较两组一般人口学信息及临床特征等方面的差异,找出患者服药依从性的影响因素。结果50例患者因未完成急性期治疗和电话变更失访,108例患者进入结果分析,其中服药依从性好者77例(71.30%)。服药依从性好组中,男性占比为33.77%(26/77),年龄≤25岁者占比48.05%(37/77),本科学历占比58.44%(45/77),精神疾病家族史占比23.38%(18/77)。两组的性别、年龄、受教育程度、精神疾病家族史、婚姻、医保类型、发病年龄、首次病程、总病程、病程特点等比较,差异均无统计学意义(P>0.05);两组17项汉密尔顿抑郁量表(HAMD-17)中的条目7(工作和兴趣)、条目10(精神性焦虑)、条目14(性症状)≥1分的比例比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,HAMD-17量表中的条目10(精神性焦虑,OR=2.721,95%CI:1.126~6.572)和条目14(性症状,OR=3.560,95%CI:1.050~12.072)是抑郁症患者服药依从性的影响因素。结论本研究显示,患者焦虑症状和性功能障碍可能是影响服药依从性的重要原因,在临床实践过程中需有针对性地及时给予正确的引导和调整治疗,从而进一步提高抑郁症患者的服药依从性。

Objective To explore the influencing factors of medication compliance in patients with depression.Methods A total of 158 patients with depression admitted to the outpatient department of Beijing Anding Hospital affiliated to Capital Medical University from November 2016 to October 2019 were recruited as the research subject.Telephone interviews were conducted at the end of the study(the mean time is 1 year).According to the total score of Medication Adherence Report Scale(MARS),the patients were divided into compliance group(n=77,MARS total score≥6)and noncompliance group(n=31,MARS total score<6).The differences in general demographic information and clinical characteristics between the two groups were analyzed and compared,to find out the influencing factors of patients'medication compliance.Results At last,50 patients were lost to follow-up due to incomplete acute treatment and telephone change,and 108 patients entered the result analysis,of which 71.30%had good medication compliance.In the good medication compliance group,33.77%(26/77)are male,48.05%(33/77)are younger than or equal to 25 years old,58.44%(45/77)are with bachelor degree,23.38%(18/77)haved family history of mental illness.There were no statistically significant differences between the two groups in gender,age,education level,family history of mental illness,marriage,type of medical insurance,age of onset,first course of disease,total course of disease,and characteristics of course between the two groups(P>0.05),while the differences between the two groups in terms of the item 7(work and interest),item 10(mental anxiety),item 14(sexual symptoms)in HAMD-17 scale were statistically significant(P<0.05).Logistic regression analysis showed that item 10(mental anxiety)and item14(sexual symptoms)in HAMD-17 were the main influencing factors for medication compliance(OR=2.721,95%CI:1.126-6.572;OR=3.560,95%CI:1.050-12.072).Conclusions This study showed that anxiety symptoms and sexual dysfunction may be important factors affecting medication compliance.In the process of clinical practice,targeted and timely guidance and adjustment of treatment should be given,so as to further improve medication compliance of patients with depression.