预防自杀的认知行为治疗对自杀未遂抑郁症患者疗效的随机对照研究

A randomized controlled study on the effectiveness of suicide prevention cognitive behavioral therapy for depression patients with suicide attempt

目的探讨预防自杀的认知行为治疗对自杀未遂抑郁症患者的疗效。方法纳入2021年9月至2022年8月北京回龙观医院住院的自杀未遂抑郁症患者112例,采取随机数字表区组随机化法将患者分为干预组和对照组,干预组给予12次预防自杀的认知行为治疗,对照组给予相同时间和频次的支持性心理治疗,分别在基线和治疗4周后、治疗结束和随访时(第4、8、12周末),采用患者健康问卷抑郁量表(Patient Health Questionnaire Depression Scale,PHQ-9)和贝克自杀意念量表中文版(Beck Scale for Suicide Ideation-Chinese Version,BSI-CV)评估患者抑郁症状、自杀意念和自杀倾向的变化。2组间一般资料及量表评分比较采用t检验、Mann-Whitney秩和检验、χ^(2)检验比较,采用重复测量方差分析对各结局指标的组间和时间效应进行分析。结果2组PHQ-9评分各时点变化均为下降趋势,且组别和时间交互作用有统计学意义(F=2.75,P=0.047)。自第8周起干预组PHQ-9评分低于对照组差异有统计学意义(t=4.95,P<0.05)。2组间BSI-CV最近1周自杀意念总分时间效应和组别效应均有统计学意义(F=96.78、6.35,均P<0.05),但组别和时间交互作用不显著;干预组评分在第8周和第12周时低于对照组差异有统计学意义(Z=-3.11、-3.30,均P<0.01)。2组间BSI-CV最近1周自杀倾向总分时间效应有统计学意义(F=11.83,P<0.05),组别和时间交互作用无统计学意义(F=2.56,P=0.059),组别效应无统计学意义(F=0.001,P=0.975);随时间变化2组第4、8、12周时BSI-CV最近1周自杀倾向总分均低于基线,组内差异比较均有统计学意义。结论预防自杀的认知行为治疗对自杀未遂抑郁症患者抑郁症状和自杀意念的干预效果均优于一般支持性心理治疗,而对自杀倾向干预效果不明显。

Objective:To investigate the effectiveness of suicide prevention cognitive behavioral therapy for depression patients with suicide attempt.Methods:Eligible participants were recruited from the inpatient department of Beijing Huilongguan Hospital from September 2021 to August 2022.A total of 112 patients were randomly allocated into the intervention group(56 cases)and the control group(56 cases)by a random number table.Patients in the intervention group received 12 sessions of cognitive behavioral therapy for suicide prevention over 8 weeks,while participants in the control group received supportive psychotherapy.Patient Health Questionnaire Depression Scale(PHQ-9)and the Beck Scale for Suicide Ideation-Chinese Version(BSI-CV)were used to assess changes in depressive symptoms,suicidal ideation,and suicidal tendencies in both groups at baseline,4-week of treatment,the end of treatment,and at follow-up(weekends 4,8,12).General data and scale scores between the two groups were analyzed by t test,Mann-Whitney rank sum test,andχ^(2)test;repeated measure ANOVA were used to assess the baseline and intervention effects.Results:The change of PHQ-9 at each time point of the 2 groups showed a downward trend,and the group x time interaction was significant(F=2.75,P=0.047).Since the 8th week,the PHQ score in the intervention group was significantly lower than that in the control group(t=7.03,P<0.05).Time and group effect were significant in the four time points of the total score of suicidal ideation in the last week in BSI-CV(F=96.78,6.35,both P<0.05),but the interaction between group and time was not significant.At weeks 8 and 12,the scores of the intervention group were lower than those of the control group(Z=-3.11,-3.30;both P<0.01).In BSI-CV,time effects in the total score of suicidal intention was significant at four time points(F=11.83,P<0.05),but the interaction between group and time was not significant(F=2.56,P=0.059).There was no significant difference in suicide tendency between the two groups at each time point(F=0.001,P=0.975).The total scores of suicidality in 2 groups at 4,8 and 12 weeks were all lower than baseline(P<0.05).Conclusions:Compared with the control group,the cognitive behavioral therapy for suicide prevention showed superior effects on suicidal ideation and depression,but the intervention effect on suicidal tendency was not significant.Further studies are needed to investigate the long-term effects of cognitive behavioral therapy for suicide prevention in patients with depression who have attempted suicide.