抑郁症患者药物治疗一年后社会功能与生活质量变化及预测研究

Changes and Prediction of Social Functional Disability and Quality of Life in Patients with Major Depressive Disorder over the Course of 1-Year Medication

目的探讨抑郁症患者药物治疗一年后的社会功能恢复情况、生活质量的变化及其预测因素。方法纳入抑郁症患者54例,在基线(0)以及药物治疗后1个月(1 m)、2个月(2 m)、3个月(3 m)、6个月(6 m)、9个月(9 m)和12个月末(12 m)应用汉密尔顿抑量表(HAMD-17)评估抑郁症状、席汉残疾量表(SDS)和生活质量与满意度程度问卷(Q-LES-QSF)分别评估社会功能和生活质量。分析不同时间点症状与社会功能恢复情况,采用相关与回归分析功能恢复的影响因素。结果54例抑郁症患者中,27例完成了12个月的随访,2例在12 m时复发;患者组基线时SDS量表总分(SDS_(0))较对照组高(t=12.161,P<0.001),Q-LES-Q-SF评分(Q-LES-Q-SF_(0))较对照低(t=12.260,P<0.001);患者组不同时间点HAMD、SDS总分及因子分、Q-LES-Q-SF总分分别比较,差异均有统计学意义,F值分别为:65.987、28.944、23.589、27.070和28.668,P均<0.001;HAMD0与年龄呈负相关,HAMD评分与同时点的SDS评分呈正相关,与同时点的Q-LES-Q-SF评分呈负相关,相关系数检验均有统计学意义;3 m时,HAMD评分变化(HAMD_(3m-0))与SDS评分变化(SDS_(3m-0))呈正相关,与Q-LES-QSF评分变化(Q-LES-Q_(3m-0))呈负相关;12 m时,HAMD评分变化(HAMD_(12 m-0))与SDS评分变化(SDS_(12 m-0))呈正相关,与Q-LESQ-SF评分变化(Q-LES-Q_(12 m-0))呈负相关;回归分析显示,SDS_(0)、Q-LES-Q_(0)可以预测SDS_(3m-0),R^(2)=0.391,SDS_(0)、工作状况为全职可以预测SDS_(12 m-0),R^(2)=0.640;.Q-LES-Q_(0)可以预测Q-LES-Q_(3m-0),R^(2)=0.294,而.Q-LES-Q_(0)、工作状况为全职可以预测Q-LES-Q_(12 m-0),R^(2)=0.591。结论长期、规律的药物治疗可改善抑郁症患者的功能障碍,症状缓解是功能水平、生活质量提升的基础,一定程度上增加工作饱和度可能有助于改善远期社会功能与生活质量。

Objective To investigate the changes in social function impairment and quality of life and their predictive factors in patients with major depressive disorder(MDD)over the course of 1-year drug treatment.Methods A total of 54 MDD patients were enrolled for the study.The 17-item Hamilton Rating Scale for Depression(HAMD-17,hereafter referred to simply as HAMD),Sheehan Disability Scale(SDS),and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form(Q-LES-Q-SF)were used to evaluate depressive symptoms,social functioning,and quality of life,respectively,at baseline(0),as well as 1 month(1 m),2 months(2 m),3 months(3 m),6 months(6 m),9 months(9 m),and 12 months(12 m)after medication started.The symptoms and the recovery of social function at different time points was analyzed,and correlation analysis and regression analysis were done to explore the influencing factors of functional recovery.Results Among the 54 MDD patients,27 completed the 12-month follow-up,and 2 patients relapsed at 12 m.The total baseline score of SDS(SDS0)in MDD patients was higher than that in healthy controls(t=12.161,P<0.001),and the baseline score of Q-LES-Q-SF(Q-LES-Q-SF_(0))was lower than that in the controls(t=12.260,P<0.001).Comparison of the HAMD score,SDS total score and the factor scores,and Q-LES-Q-SF total scores of the MDD patients at different time points showed significant differences,presenting an F value of 65.987,28.944,23.589,27.070 and 28.668,respectively(all P<0.001).HAMD_(0)was negatively correlated with age.The HAMD score was positively correlated with SDS score of the same time point and negatively correlated with Q-LES-Q-SF score of the same time point.At 3 m,the change in HAMD score(HAMD_(3 m-0))was positively correlated with the change in SDS score(SDS_(3 m-0))and negatively correlated with the change in Q-LES-Q-SF score(Q-LES-Q_(3 m-0)).At 12 m,the change in HAMD score(HAMD_(12 m-0))was positively correlated with the change in SDS score(SDS_(12m-0))and negatively correlated with the change in Q-LES-Q-SF score(Q-LES-Q_(12 m-0)).Regression analysis revealed that SDS_(0) and.Q-LES-Q_(0)could be used to predict SDS_(3 m-0),R^(2)=0.391,while SDS_(0)and full-time employment status could be used to predict SDS_(12m-0),R^(2)=0.640.Q-LES-Q_(0)could be used to predict Q-LES-Q_(3 m-0),R^(2)=0.294,while.Q-LES-Q_(0)and full-time employment status could be used to predict Q-LES-Q_(12 m-0),R^(2)=0.591.Conclusion Long-term regular medication can improve social dysfunction in patients with MDD and symptom relief is the basis for improvement of social function level and quality of life,while increasing employment saturability to some extent may help improve the long-term social function and quality of life.