抑郁症患者服药依从率及其影响因素的Meta分析

Medication adherence rate and its influencing factors in patients with depression:a Meta-analysis

目的通过Meta分析探讨抑郁症患者的服药依从率及其影响因素。方法计算机检索PubMed、Web of Science、Embase、the Cochrane Library、Scopus、Ovid、中国生物医学文献数据库(CBM)、中国知网、维普、万方数据库中抑郁症患者服药依从性影响因素的相关文献,检索时间从建库至2023年9月。由2名研究人员独立筛选文献,并对纳入文献进行数据提取和质量评价,使用Stata 17.0软件进行分析。结果最终纳入30篇文献,总样本量为550115例,其中服药依从的患者有230669名,抑郁症患者服药依从率为53.8%[95%CI(45.1%,62.5%),P<0.001]。亚组分析结果显示,国内患者的依从率(48%)低于国外患者(60%);2004—2018年服药依从率呈上升趋势,2019年后降低;来自门诊的患者依从率(50%)低于其他来源的患者;使用服药信念量表(Beliefs about Medical Questionnaire,BMQ)测量的患者依从率(60%)高于其他量表;诊断标准使用《中国精神障碍分类与诊断标准》第3版(CCMD-3)的患者服药依从率最低(23%)。Meta分析结果显示,月收入水平[OR=2.45,95%CI(0.85,4.61),P=0.046]、工作状况[OR=2.35,95%CI(1.31,4.19),P=0.004]、社会支持水平[OR=2.82,95%CI(1.24,6.39),P=0.013]、病耻感[OR=3.48,95%CI(1.84,6.56),P<0.001]、人格特质[OR=1.43,95%CI(0.68,3.01),P=0.001]、对医务人员态度[OR=7.60,95%CI(3.64,15.82),P<0.001]、焦虑[OR=1.60,95%CI(1.24,2.07),P<0.001]、疾病认知[OR=5.53,95%CI(2.41,12.67),P<0.001]和药物种类[OR=0.49,95%CI(0.32,0.76),P=0.001]是抑郁症患者服药依从性的影响因素。结论现有研究证据表明,目前抑郁症患者服药依从率较低。国内外、不同时间段、不同来源、使用不同测量工具和诊断标准等患者的服药依从率存在明显差异;一般因素(月收入水平、工作状况)、社会心理因素(社会支持水平、病耻感、人格特质、对医务人员态度)、疾病因素(焦虑、疾病认知)和药物种类是抑郁症患者服药依从性的主要影响因素,今后需针对相关因素实施个性化的干预措施,以提高患者的服药依从性,改善抑郁症的预后。

Objective To explore the rate of medication compliance and its influencing factors in patients with depression by Meta-analysis.Methods The relevant literature on the influencing factors of medication compliance of patients with depression were searched in PubMed,Web of Science,Embase,the Cochrane Library,Scopus,Ovid,CBM,CNKI,VIP and WanFang Data.The search period was from the establishment of the databases to September 2023.The literature was screened independently by two researchers,and data extraction and quality evaluation were carried out for the included literature.Stata 17.0 software was used for analysis.Results 30 articles were included,with a total sample size of 550115 cases,among which 230669 patients had medication compliance.The medication compliance rate of depression patients was 53.8%[95%CI(45.1%,62.5%),P<0.001].Subgroup analysis showed that the compliance rate of domestic patients(48%)was lower than that of foreign patients(60%).The rate of medication compliance increased from 2004 to 2018,and decreased after 2019.Patients from outpatient clinics had a lower adherence rate(50%)than patients from other sources;the patient compliance rate(60%)measured by Beliefs about Medical Questionnaire(BMQ)was higher than other types of scales.Patients using Chinese classification and diagnosis criteria for mental disorders(3rd Edition)(CCMD-3)had the lowest rate of medication compliance(23%).The results of Meta-analysis showed that monthly income level[OR=2.45,95%CI(0.85,4.61),P=0.046],working status[OR=2.35,95%CI(1.31,4.19),P=0.004],social support level[OR=2.82,95%CI(1.24,6.39),P=0.013],stigma[OR=3.48,95%CI(1.84,6.56),P<0.001],personality traits[OR=1.43,95%CI(0.68,3.01),P=0.001],attitude towards medical staff[OR=7.60,95%CI(3.64,15.82),P<0.001],anxiety[OR=1.60,95%CI(1.24,2.07),P<0.001],disease cognition[OR=5.53,95%CI(2.41,12.67),P<0.001]and drug types[OR=0.49,95%CI(0.32,0.76),P=0.001]were influencing factors for medication compliance in patients with depression.Conclusion The existing evidence showed that the medication compliance rate of depression patients was low.There were significant differences in the medication compliance rates of patients at home and abroad,in different time periods,from different sources,using different measuring tools and diagnostic criteria.General factors(monthly income level,working status),psychosocial factors(social support level,stigma,personality traits,attitude toward medical personnel),disease factors(anxiety,disease cognition)and drug types were the main influencing factors of medication compliance of patients with depression.In the future,personalized intervention measures should be implemented based on relevant factors to improve medication compliance of patients and improve the prognosis of depression.