失眠患者数字化失眠认知行为治疗选择倾向的影响因素分析

Affecting factors of the selection for electronically-delivered cognitive behavioral therapy among patients with insomnia

目的初步探索影响失眠患者对数字化失眠认知行为治疗(electronically-delivered cognitive behavioral therapy for insomnia,e-CBTI)选择的因素,为e-CBTI在临床推广提供实证证据。方法于2022年11月至2023年7月,采用方便抽样法在全国38家公立医院门诊及其附近社区收集样本,共纳入18~65岁失眠患者756例。根据患者是否选择e-CBTI治疗进行分组,其中605例患者(605/756,80.0%)选择e-CBTI治疗(e-CBTI组),151例患者(151/756,20.0%)未选择参与e-CBTI治疗(对照组)。通过结构化临床访谈,根据睡眠模式及障碍诊断访谈以及DSM-5中相关诊断标准,对2组失眠患者的失眠相关症状、精神障碍、其他睡眠障碍及自杀自伤进行他评,组间差异比较采用t检验或卡方检验,并采用Logistic回归分析确定e-CBTI选择的影响因素。结果与对照组相比,e-CBTI组女性比例(χ^(2)=4.29)以及文化水平较高(χ^(2)=5.76),而居住在乡镇(χ^(2)=6.87)比例较低(均P<0.05)。与对照组相比,e-CBTI组日间症状的比例较高,包括注意力或记忆力下降(χ^(2)=16.42)、功能受损或表现下降(χ^(2)=6.75)、情绪变化(χ^(2)=4.71)以及积极性、精力或动力不足(χ^(2)=4.77,均P<0.05)。e-CBTI组较对照组睡眠时相延迟倾向(χ^(2)=6.61)、广泛性焦虑障碍(χ^(2)=6.22)、自杀意念(χ^(2)=10.45)和非自杀性自伤(χ^(2)=5.19)比例较高,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,居住地类型(OR=0.53,95%CI=0.29~0.95)、文化程度(OR=2.42,95%CI=1.34~4.37)、注意力或记忆力(OR=1.95,95%CI=1.11~3.42)及功能受损或表现受损(OR=1.80,95%CI=1.15~2.82)以及自杀意念(OR=3.12,95%CI=1.29~7.58)影响e-CBTI的选择,失眠的夜间症状,包括入睡困难、睡眠维持困难和过度早醒与e-CBTI选择倾向未见相关。结论失眠的日间症状和自杀意念是促使失眠患者选择e-CBTI的重要因素。

Objective:To explore the factors influencing electronically-delivered cognitive behavioral therapy for insomnia(e-CBTI)selection among patients with insomnia,and to provide empirical evidence for the clinical promotion of e-CBTI.Methods:Between November 2022 and July 2023,a convenience sampling method was employed to collect samples from 38 public hospitals and their surrounding communities.A total of 756 insomnia patients aged 18-65 years were included in the study.Based on their choice to participate in e-CBTI treatment,patients were divided into two groups:605 patients(605/756,80.0%)chose to participate in e-CBTI treatment,while 151 patients(151/756,20.0%)did not.Rater-rated structured clinical interviews were applied in the current study,assessing individual′s insomnia symptoms,mental disorders,other sleep disorders,and suicidality and self-injury.The chi-square test and logistic regression were applied in data analyses.Results:Compared to the control group,the e-CBTI group had a higher proportion of females(χ^(2)=4.29)and a higher educational level(χ^(2)=5.76),while the proportion of living in rural areas was lower(χ^(2)=6.87),all with P<0.05.Additionally,the e-CBTI group exhibited a higher proportion of daytime symptoms compared to the control group,including decreased attention or memory(χ^(2)=16.42),impaired function or performance(χ^(2)=6.75),mood changes(χ^(2)=4.71),and reduced enthusiasm,energy,or motivation(χ^(2)=4.77),all with P<0.05.The e-CBTI group also showed a higher tendency for delayed sleep phase(χ^(2)=6.61),generalized anxiety disorder(χ^(2)=6.22),suicidal ideation(χ^(2)=10.45),and non-suicidal self-injury(χ^(2)=5.19),all with statistically significant differences(P<0.05).Multivariate logistic regression analysis revealed that the type of residence(OR=0.53,95%CI=0.29-0.95),educational level(OR=2.42,95%CI=1.34-4.37),decreased attention or memory(OR=1.95,95%CI=1.11-3.42),impaired function or performance(OR=1.80,95%CI=1.15-2.82),and suicidal ideation(OR=3.12,95%CI=1.29-7.58)remained significant influential factors in the selection of e-CBTI.Insomnia′s nighttime symptoms,including difficulty falling asleep,difficulty maintaining sleep,and early morning awakenings,were not associated with the inclination to choose e-CBTI.Conclusions:Daytime symptoms of insomnia and suicidal ideation are significant factors that prompt insomnia patients to choose e-CBTI.