社区心理干预对老年COPD合并负性情绪患者的影响

Effects of community mental intervention on elderly COPD patients with negative emotion

目的探讨社区心理干预对老年慢性阻塞性肺疾病(COPD)合并负性情绪(焦虑和/或抑郁)患者的影响。方法采用GAD-7焦虑症筛查量表及PHQ-9抑郁症筛查量表对2019年7月1日—2021年6月30日社区管辖的503例老年COPD患者进行调查,筛查出的合并焦虑和/或抑郁的患者随机分成观察组和对照组。对照组参照《慢性阻塞性肺疾病基层诊疗指南(2018年)》给予规范治疗,观察组在与对照组相同治疗基础上给予3个月的心理干预治疗。比较干预前后2组的CAT(COPD Assessment Test)评分、GAD-7及PHQ-9分值、FEV1%pred值及外周血清IL-8、TNF-α、MPO等水平变化。结果筛查出老年COPD合并焦虑和/或抑郁患者218例(占比43.34%)。干预前,观察组和对照组患者年龄、性别构成、合并抑郁比率、合并焦虑比率及合并抑郁+焦虑比率差异均无统计学意义(P>0.05);干预3个月后,观察组CAT评分、GAD-7分值、PHQ-9分值、TNF-α及MPO水平均下降,与干预前比较差异均有统计学意义(P<0.05);FEV1%pred值及IL-8水平与干预前比较差异均无统计学意义(P>0.05)。干预后,观察组CAT评分、GAD-7分值、PHQ-9分值、TNF-α及MPO水平均明显低于对照组(P<0.05);2组FEV1%pred值及IL-8水平差异均无统计学意义(P>0.05)。结论社区心理干预措施可能改善老年COPD合并焦虑和/或抑郁患者的呼吸道症状、焦虑和抑郁程度,减轻稳定期COPD的炎症反应,在社区基层医疗中有一定的应用价值。

Objective To explore the effects of community mental intervention on elderly patients with chronic obstructive pulmonary disease(COPD)complicated with negative emotion(anxiety and/or depression).Methods GAD-7Anxiety Screening Scale and PHQ-9Depression Screening Scale were used to investigate503elderly COPD patients managed by the communities from July1,2019to June30,2021.The screened patients with anxiety and/or depression were randomly divided into observation group and control group.The control group was given standardized treatment according to the Basic Diagnosis and Treatment Guidelines for Chronic Obstructive Pulmonary Disease(2018),and the observation group receivedmental intervention for3months on the basis of the control group.The CAT(COPD Assessment Test)score,GAD-7scoresand PHQ-9scores,FEV1%pred,andthe levels of peripheral serum IL-8,TNF-αand MPO were compared between the two groups before and after the intervention.Results 218elderly COPD patients with anxiety and/or depression were screened,accounting for43.34%of the elderly COPD patients.Before intervention,there was no significant difference in age,gender,combined depression rate,combined anxiety rate and combined depression+anxiety rate between the two groups(P>0.05).After3months of intervention,the scores of CAT,GAD-7,PHQ-9and the levels of TNF-αand MPO of the observation group decreased,and the differences were statistically significant compared with those before intervention(P<0.05),but there were no significant difference in FEV1%pred and IL-8level compared with those before intervention(P>0.05).After the intervention,the scores of CAT,GAD-7,PHQ-9and the levels of TNF-αand MPO of the observation group were lower than those of the control group(P<0.05);there were no significant difference in FEV1%pred and IL-8 level between two groups(P>0.05).Conclusion Community mental intervention may improve the respiratory symptoms of elderly COPD patients with anxiety and/or depression,reduce the degree of anxiety and depression,and alleviate the inflammatory reaction of stable COPD.It has a certain application value in community primary health care.