正念干预对抑郁症患者病耻感和应对方式的影响

Effects of mindfulness-based intervention on stigma and coping style in patients with depression

目的:探讨正念干预在抑郁症患者中的应用价值。方法:选取2017年3-12月我院心理科抑郁症住院患者86例,按照住院号先后顺序随机分为观察组与对照组,每组43例。常规药物治疗基础上,对照组予以常规健康教育及心理干预,观察组在对照组基础上实施正念干预,两组均连续干预2周。对比两组干预前后正念水平(FFMQ评分)、病耻感(SSPM)、应对方式(CSQ)、自我效能感(GSES评分)及干预后治疗依从性,干预结束随访3个月,对比两组干预前及干预后抑郁症状(HAMD-17评分)。结果:①正念水平:干预前两组FFMQ各因子评分及总分比较无显著差异(P>0.05),干预后观察组FFMQ各因子评分及总分高于对照组(t=5.625,5.146,4.582,7.339,7.155,12.306;P<0.05);②病耻感:干预前两组SSPM各因子评分及总分比较无显著差异(P>0.05),干预后观察组SSPM各因子评分及总分低于对照组(t=-6.270,-5.835,-2.128,-6.836;P<0.05);③应对方式:干预前两组CSQ各因子评分比较无显著差异(P>0.05),干预后两组幻想、合理化评分比较仍无显著差异(P>0.05),干预后观察组解决问题(t=4.485)及求助(t=3.562)评分高于对照组,回避(t=-2.301)、自责(t=-6.044)评分低于对照组(P<0.05);④自我效能感:干预前两组GSES评分比较无显著差异(P>0.05),干预后观察组GSES评分高于对照组(t=5.889,P<0.05);⑤治疗依从性;干预后观察组治疗依从性93.02%高于对照组76.74%(χ~2=4.441,P<0.05);⑥抑郁症状:干预前两组HAMD-17各因子评分及总分比较无显著差异(P>0.05),干预结束随访3个月后观察组HAMD-17中除体质量因子评分与对照组比较无显著差异,其余各因子评分及总分低于对照组(t=-10.508,-18.739,-6.905,-7.541,-13.701;P<0.05)。结论 :正念干预有利于提高抑郁症正念水平,降低病耻感,改善应对方式,有利于提高自我效能感及治疗依从性,进而促进抑郁症状缓解。

Objective:To explore the application value of mindfulness-based intervention in patients with depression.Methods:A total of 86hospitalized patients with depression from March 2017to December 2017were selectedand divided into the observation group and the control group randomly according to the order of hospitalization,with43cases in each group,On the basis of conventional drug treatment,the control group was given routine health education and psychological intervention,and the observation group was given mindfulness-based intervention on thebasis of the control group,and the two groups were all intervened for 2weeks,The level of mindfulness(FFMQscore),stigma(SSPM),coping style(CSQ)and self-efficacy(GSES score)before and after the intervention and treatment compliance after intervention were compared between the two groups,Following up for 3months after intervention,the depression symptoms(HAMD-17score)before and after intervention were compared between the twogroups.Results:①There was no significant difference in scores of FFMQ between the two groups before intervention(P>0.05),After intervention,the scores of each factor and total scores of FFMQ in the observation group werehigher than those in the control group(t=5.625,5.146,4.582,7.339,7.155,12.306,P<0.05),②There was no significant difference in the scores of each factor and total scores of SSPM among the two groups before intervention(P>0.05).After intervention,the scores of each factor and total scores of SSPM in the observation group were lowerthan those in the control group(t=-6.270,-5.835,-2.128,-6.836,P<0.05),③There was no significant difference inthe scores of CSQ between the two groups before intervention(P>0.05),After intervention,there was no significantdifference between the two groups in fantasy and rationalization scores(P>0.05),After intervention,the scores ofproblem solving and help seeking in the observation group were higher than those in the control group,and thescores of avoidance and self blame were lower than those in the control group(t=-4.485,-3.562,-2.301,-6.044,P<0.05),④There was no significant difference in the GSES score between the two groups before intervention(P>0.05),After intervention,the GSES score of the observation group was higher than that of the control group(t=5.889,P<0.05).⑤ After treatment,the compliance rate of the observation group was 93.02%(40/43),which washigher than that of the control group 76.74%(33/43)(χ2=4.441,P<0.05),⑥There was no significant difference inHAMD-17scores and total scores between the two groups before intervention(P >0.05),Following up for 3months after intervention,there was insignificant difference in HAMD-17scores except the body mass factor scorebetween the observation group and the control group,and the scores of other factors and total scores were lower thanthose of the control group(t=-10.508,-18.739,-6.905,-7.541,-13.701,P<0.05).Conclusion:Mindfulness-basedintervention is beneficial to improve the level of depression,to reduce the sense of shame,and to improve the copingstyle,Besides,it's helpful to improve the sense of self efficacy and the compliance of the treatment,and to promotethe relief of depressive symptoms.