认知行为治疗联合系统性家庭治疗改善轻中度产后抑郁

Combined cognitive behavior therapy with systematic family therapy in patients with mild to moderate post-partum depression

目的:探讨认知行为疗法联合系统性家庭疗法对轻中度产后抑郁的改善作用。方法:将249例产后42天的轻中度产后抑郁患者随机分为两组,一组接受常规的产后护理(对照组,n=128),一组在此基础上接受为期3个月的认知行为治疗联合系统性家庭治疗(心理治疗组,n=121)。在产后6、12、18和24个月时对两组患者进行随访。使用爱丁堡产后抑郁问卷(EPDS)和匹兹堡睡眠质量指数问卷(PSQI)在干预前、干预结束时和产后6、12、18、24个月时分别对两组进行评定。结果:共213例患者(心理治疗组104例、对照组109例)完成试验。干预结束时,心理治疗组的EPDS总分[(11.3±2.9)vs.(13.6±3.5)]、PSQI总分[(9.5±3.7)vs.(12.1±4.1)]及睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍和日间功能障碍因子分均低于对照组(均P<0.01);与干预前相比,在研究的各阶段,两组的EPDS和PSQI总分均有所下降,心理治疗组的降分率高于对照组的同期降分率(均P<0.01)。干预后,与同一阶段的对照组相比,心理治疗组的入睡时间更短(P<0.01)、睡眠时间更长(P<0.05)、夜间觉醒次数更少(P<0.05)。结论:本研究提示,认知行为疗法联合系统性家庭疗法可以减轻轻中度产后抑郁患者的抑郁情绪,改善其睡眠质量。

Objective： To explore the effect of cognitive behavior therapy combined with systematic family therapy on depression and sleep quality in patients with mild to moderate postpartum depression. Methods： Two hundred and forty-nine primiparas who had given birth 42 days before and had been diagnosed with mild to moderate post-partum depression were randomly divided into the psychological intervention group （n = 121） and the control group （n = 128）. The control group received conventional postpartum care. The psychological intervention group received conventional postpartum care combined with 3-month psychological intervention, including cognitive be- havior therapy and systematic family therapy. Both groups were followed-up at 6, 12, 18 and 24 months after giving birth. They were assessed with the Edinburgh Postnatal Depression Scale （EPDS） and Pittsburgh Sleep Quality In- dex （PSQI） before and after intervention and every time of follow-up. Results： Totally 213 patients went to the end of the experiment, including 104 patients in the intervention group and 109 in the control group. After intervention, the scores of EPDS [（ 11.3 ±2. 9） vs. （13.6±3.5）], PSQI[（9.5±3.7） vs. （ 12. 1 ±4. 1）], sleep quality[（ 1.8± 0. 7） vs. （2. 4±0. 6）], sleep latency[ （1.4±0. 9） vs. （1.9 ±0. 9）], sleep duration[ （1.8 ±0. 8） vs. （2.3 ±0. 8）], habitual sleep efficiency[ （ 1.6 ± 0. 8） vs. （2. 5± 0. 6） ], sleep disturbance[ （ 1.2 ± 0. 5） vs. （ 1.3 ± 0. 5） ] and day time dysfunction [（ 1.8 ± 0. 7） vs. （2.7 ± 0. 5）] were lower in the intervention group than in the control group. Compared with before intervention, the two groups total scores of EPDS and PSQI of each study stage de- creased somewhat, and the score-reducing rates were higher in the intervention group than in the control group （Ps 〈 0. 01）. At each following-up time, the controlled group had shorter sleep incubation period, longer sleep incuba- tion, and less night awakenings （Ps 〈 0. 05）. Conclusion： It suggests that psychological intervention including cog- nitive behavior therapy combined with systematic family therapy could relieve depression symptom and improve sleep quality in patients with mild to moderate post-partum depression.