结构式团体认知行为治疗对轻症抑郁患者失眠症状的影响

Effect of structured group cognitive behavioral therapy on insomnia symptoms in patients with mild depression,minor depressive disorder or dysthymia

目的:分析团体认知行为(GCBT)对轻症抑郁患者失眠的改善作用并探索影响失眠改善的因素。方法:147例轻症抑郁患者接受GCBT治疗。在基线、治疗4周、8周和12周对患者进行HAMD-17评估,根据治疗12周HAMD-17总分减分率将患者分为抑郁治疗显效组(减分率≥50%)和非显效组(减分率<50%),对两组各项数据进行比较,采用多元回归分析探索影响失眠改善的因素。结果:与基线相比,治疗12周时患者HAMD-17睡眠因子得分显著下降(t=-5.634,P<0.01),患者的入睡困难(Z=-3.065,P=0.002)、睡眠不深(Z=-5.412,P<0.001)和早醒症状(Z=-2.635,P=0.008)显著改善。显效组HAMD-17睡眠因子分治疗4周就显著降低(P<0.001),两组在治疗4周和12周时差异具有统计学意义(P均<0.001)。多重线性回归分析显示,抑郁治疗是否显效、性别和受教育年限为失眠改善的预测因素。结论:经过GCBT治疗后轻症抑郁患者失眠症状明显改善,包括入睡困难、睡眠不深和早醒,而且失眠症状的改善受抑郁治疗是否显效、性别和受教育年限因素的影响。

Objective:To explore the effect of group cognitive behavioral therapy(GCBT)on insomnia symptoms in patients with mild depression,minor depressive disorder or dysthymia and to analyze the factors that may affect the insomnia symptoms improvement.Method:A total of 147 patients with mild depression,minor depressive disorder and dysthymia received GCBT.The patients were assessed using HAMD-17 at baseline,week 4,8 and 12,and were divided into a markedly effective group and a non-markedly effective group based on the total score reduction rate of HAMD-17≥50%after the 12-week treatment.The differences between two groups were compared on scores of HAMD-17.Multiple linear regression was used to explore the factors affecting the improvement of insomnia.Results:After 12 weeks of treatment,the sleep factor scores of HAMD-17 decreased significantly(t=-5.634,P<0.01).The items of falling asleep(Z=-3.065,P=0.002),lack of sleep(Z=-5.412,P<0.001)and early awakening(Z=-2.635,P=0.008)were significantly improved.The sleep factor scores in the markedly effective group were significantly decreased at week 4(P<0.001).The difference comparison between two groups was statistically significant at 4 week and 12 week(all P<0.001).Multiple linear regression analysis showed that depression improvement,gender and education years were the predictors of insomnia improvement.Conclusion:GCBT is effective in improving insomnia symptoms in patients with mild depression,minor depressive disorder and dysthymia Furthermore,improvement in sleep symptoms is strongly associated with improvement in depressive symptoms,gender and years of education.