肺结核患者心理状况与服药依从性的研究

A study on the relationship between mental health status and medication adherence in tuberculosis patients

目的了解杭州市肺结核患者心理状况与服药依从性的关系。方法采用系统抽样方法,对杭州市≥15周岁的973例肺结核患者进行问卷调查,包括社会人口学资料和焦虑自评量表(SAS)、抑郁量表(CESD)、自杀行为及Morisky服药依从性量表(MMAS)调查,并进行相关分析。结果肺结核患者SAS和CESD平均得分(39.71±8.30)和(14.16±10.77)分,均高于常模人群(P<0.01)。SAS得分≥50分者占10.48%,CESD得分≥16分占34.22%。6.17%在确诊肺结核之后曾经认真地考虑过结束自己的生命。20.55%服药依从性差,该组焦虑、抑郁和自杀意念发生率分别为15.50%、46.50%和11.00%,均高于服药依从性好组的9.18%、30.66%和4.92%(P<0.01)。服药依从性差组社会支持总分(30.71±5.15)分及客观支持(4.61±2.07)分、主观支持(19.74±4.55)分和支持利用度(6.34±1.93)分等三个维度得分均低于服药依从性好组的(34.06±7.39)、(6.62±2.27)、(20.67±5.27)和(6.77±2.23)分(P<0.01)。结论杭州市肺结核患者服药依从性与焦虑、抑郁和自杀意念等心理状况有关,建议对服药依从性差的肺结核患者开展心理干预。

Objective To evaluate the prevalence of depression,anxiety and suicide behavior in patients suffering from tuberculosis in Hangzhou and to explore their relationship with medication adherence. Methods Demographic characteristics,self-rating anxiety scale （SAS）,the center for epidemiological studies -depression （CESD）,social support rating scale （SSRS）,suicide behavior information and the morisky medication adherence scale （MMAS）were investigated in 973 tuberculosis patients who were selected by systematic random sampling.Results The means of SAS and CESD were 39.71 ±8.30 and 14.16 ±10.77 respectively,which were both higher than the norms（P〈0.01）.Totally 102 （10.48%）patients had anxiety and 333 （34.22%）were depressed.Out of 973 patients,60 （6.17%）reported suicide ideation after tuberculosis diagnosis.The prevalence of non -adherence was 20.55%,which was defined with MMAS score above one and more.The non -adherence group had higher anxiety,depression and suicide ideation prevalence than the adherence group （15.50%vs.9.18%,46.50%vs.30.66%,11.00%vs.4.92%respectively,P〈0.01）.The mean score of SSRS,subjective support,objective support and utilization of support in the non-adherence group were 30.71 ±5.15,4.61 ±2.07,19.74 ±4.55 and 6.34 ±1.93 respectively,which were 34.06 ±7.39,6.62 ± 2.27,20.67 ±5.27 and 6.77 ±2.23 in the adherence group respectively.SSRS and its three dimension scores were significantly lower in the non-adherence group than that in the adherence group （P〈0.01）.Conclusion These findings show a quite serious situation of psychological problems of tuberculosis patients in Hangzhou and suggest psychological intervention should be included in adherence intervention.