乳腺癌术后抑郁症患者综合心理干预价值的研究

目的探讨综合的心理干预措施对乳腺癌术后抑郁症患者的价值。方法采用前瞻性病例对照单盲试验研究方法,将术后病理确诊为乳腺癌、符合《中国精神障碍诊断与分类标准第3版》中抑郁症诊断标准、初始(诊断抑郁症后第1次评价)汉密尔顿抑郁量表(HAMD,24项版本)得分≥20并最终进入统计分析的87例女性患者分成对照组和干预组。两组病例治疗方法相同,基本情况差异无统计学意义。对照组41例实施常规治疗和护理,干预组46例在此基础上进行由心理咨询师参与的综合心理干预。采用HAMD抑郁量表和乳腺癌患者生活质量量表(FACT-B)分别于初始、第4周末和第6个月末对两组患者进行抑郁状况和生活质量评价,并根据患者完成化疗和放射治疗的脱漏率评价其遵医行为。采用重复测量的方差分析、计数资料χ2检验、两独立样本t检验及配对t检验进行统计分析。结果两组患者HAMD评分差异有统计学意义(P=0.000);干预组第6个月末FACT-B总分和各领域得分与初始及对照组第6个月末比较,差异均有统计学意义(P=0.000);两组间术后辅助化疗和放射治疗的脱漏率比较,差异有统计学意义(χ2=4.121P=0.042,χ2=4.586P=0.032)。结论综合心理干预能够明显改善患者的心理健康状况,增强患者治疗的依从性,提高其生活质量,非常适合乳腺癌患者各种治疗相对集中的早期。

Study on psychological intervention of postoperative depression for breast cancer patients

Objective To investigate the effect of comprehensive psychological intervention on depression of patients after mastectomy. Methods A prospective case-control single blind study was per- formed. Eighty seven female patients, who were postoperatively pathologically confirmed as breast cancer, met the diagnostic criteria of CCMD-3 （Chinese Classification and Diagnostic Criteria of Mental disorders 3rd version）, had the initial HAMD （Hamilton Rating Scale for Depression , 24 item version） score≥20, and eventually enrolled into statistical analysis, were divided into the psychological intervention group （n=46） and the control group（n=41）. Both groups were treated with same methods, with no statistical difference in basic conditions between the two groups. The control group received conventional treatment and nursing care, and the psychological intervention group conventional treatment and nursing care plus comprehensive psychological intervention. We used HAMD and the Functional Assessment of Cancer Therapy Scale-Breast （FACT-B） to assess the depression degree and quality of life for these patients before the intervention and at the end of the 4th week and the 6th month after the intervention. The compliance behaviors of patients were evaluated according to the dropout rates of chemotherapy and radiotherapy. Repeated measures analysis of variance, chi-square test, two-sample t test and paired t test were used for statistical analysis, Results There was a significant difference in HAMD score between the two groups（P=0. 000）. There was a statistical difference in the total score of FACT-B at the end of the 6th month and other items＇ scores compared with before the intervention in the intervention group, and compared with those at the 6th month in the control group（P=0. 000）. The comparison of the dropout rates of postoperative chemotherapy and radiotherapy showed a statistical difference between the two groups（X^2=4. 121 P=0. 042,X^2=4. 586 P=0. 032）. Conclusion Comprehensive psychological intervention can significantly improve the patient＇s mental health , treatment compliance behavior and quality of life, so it is very suitable for breast cancer patients after mastectomy.