难治性抑郁症患者服药信念及影响因素

Belief about medicines in patients with treatment-resistant depression and its influencing factors

目的探索难治性抑郁症患者服药信念的特征及其影响因素。方法招募106例难治性抑郁症患者（TRD），所有被试均接受人口学资料调查、汉密尔顿抑郁量表测评、服药信念量表测评。结果①TRD患者服药信念得分比较，医保付费者高于自费付费者[农村社会保险（1．11±0．96）分，医疗保险（0．84±1．33）分，自费（0．13±1．72）分，F=2．81，P〈0．01]、HAMD评分严重者高于其评分中轻度者[（1．07±1．19）分，（0．34±1．41）分，t=2．77，P〈0．01]、“既往抑郁症发作次数少”的患者高于“既往发作次数多”的患者[0次（1．10±0．99）分，1-2次（0．95±1．31）分，3次及以上（0．31±1．56）分，F=3．42，P〈0．05]、无病耻感高于有病耻感患者[（1．03±1．21）分，（0．34±1．43）分，t=2．58，P〈0．01]、“对药物了解程度高”患者高于“对药物了解程度低”患者[大部分了解（1．21±1．09）分，部分了解（0．54±1．32）分，几乎不了解（0．33±1．63）分，F=3．69，P〈0．01]、“无药物不良反应”患者高于“有药物不良反应”者[（1．04±1．24）分，（0．19±1．35）分，t=2．96，P〈0．01]；但不同性别、职业状态、不同文化程度、不同婚姻状态、有无抑郁症家族史TRD患者服药信念得分比较，差异均无统计学意义（P〉0．05）。②多元逐步线性回归分析显示，付费方式、对药物了解程度、病耻感、既往抑郁症发作次数是TRD患者服药信念的影响因素（均P〈0．01）。结论不同人口学或临床特征的TRD患者服药信念存在差异，付费方式、对药物了解程度、病耻感、既往抑郁症发作次数是影响TRD患者服药信念的影响因素。

Objective To explore the belief about medicines in patients with treatment-resistant de- pression （TRD） and its influencing factors. Methods 106 patients with TRD were recruited to complete the survey of demographic characteristics, Hamilton Depression Scale-17 （HAMD-17） and belief about Med- icine Questionnaire-Specific （BMQ-S）. Results ①The score of BMQ-s was higher in TRD patients with medical insurance than that of patients with self-funded （rural social insurance （ 1.11 ±0.96） , medical insur- ance （ 0.84± 1.33 ）, self expense （ 0. 13± 1.72）, F= 2.81, P〈0.01 ）. The score of BMQ-s was higher in TRD pa- tients with serious depression than that of patients with mild to moderate depression（ （1.07±1.19）, （0.34± 1.41） ,t=2.77,P〈0.01）.The score of BMQ-s was higher in TRD patients with fewer episodes of depression than that of patients with more episodes of depression （0 time（ 1.10±0.99）, once and twice（ 0.95± 1.31 ）, 3 times and above（0.31± 1.56）,F= 3.42,P〈0.05）.The score of BMQ-s was higher in TRD patients without stigma than those with stigma（ （ 1.03± 1.21 ）, （ 0.34± 1.43 ）, t= 2.58, P〈0.01 ） .The score of BMQ-s was high- er in TRD patients with more knowledge about the antidepressant than that of patients with less knowledge （ most of understanding （ 1.21±1.09）, part of understanding （ 0.54 ± 1.32 ）, hardly understanding （ 0.33 ± 1.63）, F= 3.69,P〈0.01 ）. The score of BMQ-s was higher in TRD patients without side effects of antidepres- sant than those with side effects （（1.04±1.24）, （0.19±1.35） ,t= 2.96,P〈0.01）. ②Stepwise multivariate linear regression analysis showed that payment methods, knowledge about the antidepressant, stigma about the antidepressant and episodes of depression were the influencing factors of BMQ-S in patients with TRD（ all P 〈0.01）. Conclusion Different demographic characteristics and clinical features have different beliefs aboutantidepressant medication in patients with TRD.The payment methods, knowledge about the antidepressant, stigma about the antidepressant and episodes of depression are the influencing factors of BMQ in patients with TRD.