“心境-促进协作医疗”模式对社区老年抑郁症的疗效评价

目的]探讨"心境-促进协作医疗"(IMPACT)管理模式对社区老年抑郁症患者疗效的影响。方法]在上海市浦东新区精神卫生网络系统中,抽取符合病例要求的60例社区老年抑郁症患者,分为干预组和对照组,每组30例,干预组实施为期18个月的IMPACT管理治疗,对照组为常规的社区精神病康复管理。使用汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)和自知力与治疗态度问卷(ITAQ)评价两组干预前与干预后第6、12、18个月时的抑郁症状及服药依从性得分变化情况,比较两组患者在干预期间的复发住院率。使用生活质量表(SF-36)评价干预前、后(第18个月)两组患者的生存质量得分变化情况。结果]在干预后第6、12、18个月,干预组患者的HAMD和SDS得分改善情况优于对照组(P均0.05),ITAQ得分提升高于对照组(P0.05)。SF-36评价中,干预组患者的躯体疼痛、一般健康状况、精力、社会功能、精神健康及健康变化得分提升均优于对照组,两组差异有统计学意义(P均0.05)。干预组无1例复发住院,对照组有6例复发住院,复发住院率为20%(χ2=6.67,P0.05)。结论]IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状,降低复发住院率,改善老年抑郁症患者的生活质量。

Effectiveness evaluation on the mode of Improving Mood-Promoting Access To Collaborative Treat-ment (IMPACT) for late-life depression

Objective] To discuss the effectiveness of the IMPACT mode for late-life depression.Methods] From Shanghai Pudong mental health network system,60 cases of elderly depressions were chosen according to the criteria for case reqirement. Of the 60 cases,30 were allocated into the intervention group who were treated with 18 months＇ IMPACT. The other 30 were included in the control group,who were treated with routine management for psychiatric rehabilitation. Depressive symptoms and medication compliance scores were compared and assessed at 6,12 and 18 months before and after intervention by using the hamilton depression scale（ HAMD）,self-rating depression scale（ SDS） and the insight and treatment attitude questionnaire（ ITAQ）. Comparison was also made in re-hospitalization during intervention between the two groups. The patients＇ quality of life was analyzed and compared between the two groups by 36-items short form health survey（ SF-36）. Results] The HAMD and SDS scores in intervention group were significantly lower than those in control group at 6,12 and 18 months after intervention（ Pall〈0. 05）. ITAQ scores were higher than those in control group（ P〈0. 05）. According to the SF-36 scores,the bodily pain,general health,vitality,social functioning and mental health scores in intervention group were extremely higher than those in control group（ Pall〈0. 05）. There was not one case of recurrence in intervention group,however,there were 6 cases of recurrence in the control group,the recurrence hospitalization rate being 20%（ χ2=6. 67,P〈0. 05）. Conclusion] IMPACT mode for late-life depression could relieve depressive symptoms effectively,thus reducing the recurrence hospitalization rate and improving the quality of life for patients.