药物联合心理剧治疗伴童年创伤抑郁症患者的随机对照研究

Antidepressants combined with psychodrama in treatment of major depressive disorder with childhood trauma:a randomized controlled trial

目的比较抗抑郁药物联合易术心理剧和抗抑郁药物联合一般健康教育对伴童年创伤抑郁症患者抑郁、焦虑、自尊、心理弹性的干预效果差异,以探索更优临床方案。方法招募重庆医科大学附属第一医院精神科门诊就诊并符合ICD-10单相抑郁发作诊断标准和童年期创伤问卷阳性的68例患者,采用随机数字表法分为抗抑郁药物联合易术心理剧治疗组和抗抑郁药物联合一般健康教育治疗组,治疗周期6个月,治疗结束后6个月随访。用汉密尔顿抑郁量表17条目(Hamilton Depression Rating Scale-17 item,HAMD-17)、贝克焦虑量表(Beck Anxiety Inventory-21 item,BAI-21)、自尊量表(Self-Esteem Scale,SES)、心理弹性量表(Connor-Davidson Resilience Scale,CD-RISC)进行评估,采用重复测量方差分析对两组间干预结束时和随访结束时抑郁焦虑情绪、自尊和心理弹性改善效果进行比较。结果(1)联合心理剧组入组35例,联合健康教育组入组33例,到随访结束时,联合心理剧组脱落4例,联合健康教育组脱落13例,两组总脱落率组间差异有统计学意义(11.4%vs 39.4%,P<0.01)。(2)干预结束时,两组抗抑郁治疗方案联合心理剧组总有效率高于联合健康教育组(63.63%vs 37.04%,χ^(2)=4.207,P<0.05)。(3)重复测量方差分析及简单效应分析结果显示,干预结束时,两组患者抑郁、焦虑评分均较干预前有降低,自尊、CD-RISC及各维度评分均较干预前有提高,除BAI总分差异无统计学意义外,HAMD、SES、CD-RISC及各维度评分差异均有统计学意义(P<0.05);随访结束时自尊和力量维度评分联合心理剧组高于联合健康教育组(P<0.05)。结论抗抑郁药物联合易术心理剧较联合一般健康教育在改善伴童年创伤抑郁症患者抑郁焦虑、自尊和心理弹性总体疗效和维持效果更好,且依从性更佳。

Objective To compare the intervention effects of antidepressants combined with Yi Shu psychodrama or with general health education on depression,anxiety,self-esteem and mental resilience in depression patients with childhood trauma so as to explore a better clinical program.Methods A total of 68 patients who met the diagnostic criteria of ICD-10 unipolar depressive episode and also were positive for Childhood Trauma Questionnaire 28 item Short Form(CTQ-SF)were recruited from the psychiatric outpatients of our hospital,and then they were randomly divided into antidepressants plus Yi Shu psychodrama group and antidepressants plus general health education group.The patients were subsequently intervened for 6 months and then followed up for another 6 months.Hamilton Depression Rating Scale-17 item(HAMD-17),Beck Anxiety Inventory-21 item(BAI-21),Self-Esteem Scale(SES)and Connor-Davidson Resilience Scale(CD-RISC)were used for assessment.Repeated-measures ANOVA was adopted to compare the effects on depression and anxiety improvement,as well as the results of self-esteem and resilience development between the 2 groups at the end of intervention and during follow-up.Results(1)There were 35 cases enrolled in the psychodrama group and 33 in the joint health education group.By the end of follow-up,4 cases were lost in the former and 13 in the latter group,with statistical difference in shedding rate between the 2 groups(11.4%vs 39.4%,P<0.01).(2)At the end of intervention,the total efficacy rate of the psychodrama group was higher than that of the health education group(63.63%vs 37.04%,Chi-square=4.207,P<0.05).(3)The results of repeated-measures ANOVA and simple effect analysis revealed that at the end of intervention,the scores of depression and anxiety were decreased in both groups,while those of self-esteem,mental resilience and its dimensions were increased,with significant differences in scores of HAMD,SES,CD-RISC and its dimensions(P<0.05),except for BAI score.During the follow-up,the scores of self-esteem and strength dimension were higher in the psychodrama group than the health education group(P<0.05).Conclusion In the treatment of major depressive disorder with childhood trauma,antidepressants combined with Yi Shu psychodrama has better overall efficacy and maintenance effect in improving depression,anxiety,self-esteem and mental resilience than the joint general health education program,with better treatment compliance as well.