家庭医生社区综合心理干预对2型糖尿病患者生存质量影响的研究

Effect of family physicians involved community-based comprehensive psychological intervention on the quality of life of type 2 diabetics

目的通过对2型糖尿病患者在常规治疗的同时进行社区综合心理干预,研究和评价干预措施对心理健康状况、生存质量及血糖指标的影响。方法研究对象为2018年1月-2019年1月间在上海市徐汇区华泾镇社区卫生服务中心已纳入慢性病管理的2型糖尿病患者180例,采用随机数字表法分为综合心理干预组和对照组。在常规治疗、慢病管理和健康教育的基础上,家庭医生和国家二级心理咨询师对干预组的研究对象进行定期的社区综合心理干预,包括每2周1次群组干预、每月1次个体干预。2组研究对象在治疗前后测评症状自评量表和糖尿病生存质量特异性量表,检测空腹和餐后2 h血糖值、糖化血红蛋白值。取得的数据资料采用Stata SE 14.0软件进行统计分析。结果 SCL-90各因子与全国常模比较差异均有统计学意义(均P<0.05)。治疗前后同组比较:干预组SCL-90中除人际关系因子外其他各因子的差异均有统计学意义(均P<0.05);对照组SCL-90中仅躯体化和恐怖因子的差异有统计学意义(均P<0.05);干预组DSQL除治疗维度外其他维度的差异均有统计学意义(均P<0.05);对照组DSQL各维度的差异均无统计学意义(均P>0.05)。治疗后2组比较:SCL-90除强迫、人际关系和精神病性外,其余各因子评分比较差异均有统计学意义(均P<0.05);DSQL除生理维度外,其余各维度评分比较差异均有统计学意义(均P<0.05);血糖指标中餐后血糖比较差异有统计学意义(P<0.05)。结论家庭医生社区综合心理干预可以改善糖尿病患者的心理健康状况与血糖指标,提高患者的生存质量。

Objective To study and evaluate the effect of intervening measures on the mental health, quality of life and blood glucose by conducting both routine treatment and community-based psychological intervention on type 2 diabetics. Methods A group of 180 type 2 diabetics was recruited from chronic disease management information system in Kangjian community service center in Shanghai from January 2018 to January 2019. These diabetics were divided into intervention group and control group randomly with random number table method. Besides routine treatment, chronic disease management and health education, the intervention group received periodical community-based psychological intervention that was conducted by family physicians and national psychological consultants biweekly on group and monthly on each individual. All subjects of the two groups were assessed with the methods of SCL-90 and diabetes-specific quality of life scale(DQOL), and their levels of FPG, PPG,HbA1 C were tested before and after the treatment. Results All factors of SCL-90 were statistically significant different from the national norm(all P<0.05). Firstly, we compared the pre-and post-treatment results within the same group. As for SCL-90, in control group the factors except interpersonal sensitivity were statistically significant(all P<0.05), while in intervention group none of the factors was statistically significant(all P<0.05). As for DSQL, in control group, the dimensions except treatment dimension were statistically significant(all P<0.05), while in intervention group none of the dimensions was statistically significant(all P<0.05). Secondly, we compared post-treatment results of the two groups. All the factors of SCL-90 were statistically significant except compulsion, interpersonal relationship and psychosis factors. All the dimensions in DSQL were statistically significant except physiological dimension, and the differences in PPG between the two groups was also statistically significant. Conclusion Family physicians involved community-based comprehensive psychological intervention could improve the mental health and blood glucose, and the quality of life of type 2 diabetics.