改善2型糖尿病患者的生活质量--快乐生活俱乐部^(TM_注)项目报告(六)

The Happy Life Club^(TM)(6):Improving mental health of patients of type 2 diabetes mellitus

背景和目的糖尿病明显地影响病人的心理健康,而心理问题又反过来影响病人参与治疗和自我管理的能力。快乐生活俱乐部的健康教练采用动机谈话和心理学技术,帮助病人改变行为,更好地管理慢性病。本项目采用凯斯勒心理忧虑量表(Kessler psychological d istress scale,K10)评价干预对参加者心理健康的影响。方法将100名55岁及以上的糖尿病患者随机分为动机谈话组(干预组)和对照组,10名社区卫生工作者接受健康心理学专家培训,为干预组提供动机谈话服务。干预组和对照组都接受常规的糖尿病管理。在干预实施前、实施后6个月和12个月时以问卷调查方式收集数据。计算K10每个指标的平均值,并按照低、中、高、很高对K10总分进行心理问题严重程度的分析。将K10总分≥16确定为焦虑或抑郁风险较高,K10总分≥30确定为心理疾病筛选阳性,比较干预前后两组间的差异。结果 (1)干预1~6个月时,干预组10个指标中有6个明显下降,差异有统计学意义。干预7~12个月时,这6个指标中有5个继续下降,另外还有2个指标开始下降。(2)干预1~6个月时,两组较高焦虑或抑郁风险的比例都明显下降,7~12个月时未呈继续下降。(3)基线时,心理疾病筛选阳性(K10分值30~50)率为6%,高于中国和澳大利亚以往调查的结果。该率在干预6个月后明显下降。结论项目干预对改善糖尿病患者非特异性心理抑郁产生积极影响。建议今后的卫生调查和干预研究中,开展对K10的心理测量学研究。建议该项目的干预组和对照组分别设置在不同的社区卫生服务中心,并增加观察样本量,以更好地评估动机谈话等心理学技术的干预效果。

Background Diabetes has a significant impact on patient＇s mental health;while poor mental health affects patient＇s ability to participate in treatment and self-management.Trained health coaches in the Happy Life Club（HLC） apply motivational interviewing（MI） and psychological skills in helping patients on behaviour change and better self-management.The Kessler Psychological Distress Scale（K10） was used in HLC pilot.The article will explore findings in pilot and discuss how the K10 applied in Chinese context.Methods 100 Residents who aged 55 year old and above and have diagnosed diabetes were recruited and allocated into MI and control groups.Ten health coaches were trained by health psychologist.K10 is complied in a self-administrated questionnaire of the pilot.Data were collected in baseline,6th month and 12th month of intervention.Average score of the 10 items were calculated and the score was scoring into low,moderate,high and very high.Percent of participant who in higher risk of anxiety or depression（score≥16） and proportion of participant with very high psychological distress score（score 30～50） were compared between MI and control group and pre-post intervention.Results（1） In the first 6 month of the pilot,participants in MI group gained significantly decreases in six of ten items of K10.In 7～12 month of the pilot,five of the six items had further improvement;while another two items（feel fidgety and feel restless） jointed the improvement.（2）Percent of higher risk of mental health problem decreased on the first 6 month of intervention and no further decrease found in 12 month observation.（3）In baseline,percent of participant at very risk of depression or anxiety was 6% which higher than Australian data.The percent decreased significantly in 6 month intervention.Conclusion The pilot demonstrated positive effect on improving mental health status of diabetes patients.Further studies on K10 in Chinese circumstance are recommended.MI and control groups should be setup in different community health centres and sample size should be increased for better estimating effect of MI in mental health improvement.