心理社会干预对首发老年抑郁症患者1年结局的影响

目的比较抗抑郁药单用与结合心理社会干预对首发老年抑郁症患者1年结局的影响。方法采用随机对照研究，将280例首发老年抑郁症患者随机分为单纯药物治疗组（以下简称药物组，140例）和药物结合心理社会干预组（以下简称干预组，140例）治疗随访1年。心理社会干预包括健康教育、家庭干预、技能训练及认知行为治疗，主要结局指标为各种原因造成的治疗中断率、疾病复发率和再入院率，次要结局指标为自知力与治疗态度问卷（ITAQ）、健康状况问卷（SF-36）、大体评定量表（GAS）和社会功能缺陷筛选量表（SDSS）评分的变化。结果①干预组和药物组总的治疗中断率分别为22．14％和45．71％，复发率分别为11．43％和23．57％，再入院率分别为5．71％和15．8％，差异均有统计学意义（P〈0．05）。干预组服药依从性（84．3％）高于药物组（63．6％），差异有统计学意义（P〈0．01）。②干预组ITAQ总分变化值、7项SF-36因子分改善值、GAS总分变化值、SDSS总分变化值均明显高于药物组，差异均有统计学意义（P〈0．01）。结论抗抑郁药结合心理社会干预治疗首发老年抑郁症患者，治疗中断率、复发率和再入院率均低于单用抗抑郁药患者，自知力、治疗依从性、生活质量、社会功能的改善优于单用抗抑郁药患者。

Effects of psychosocial intervention on one - year outcome of the first fall geriatric depression

Objective To compare the effectiveness of antidepressants alone versus combination with psychosocial intervention on one - year outcome of the first fall geriatric depression. Methods Two hundred and eighty first fall geriatric depression patients were randomly assigned to receive medication treatment alone （140 cases ） or medication combined psychosocial intervention （140 cases ） for twelve months. The psychosocial intervention consisted of psycho - education, family intervention, skills training and cognitive -behavioral therapy. The main outcome measures were the rates of discontinuation due to any cause, relapse or re -hospitalization. Secondary outcomes were assessed by the insight and treatment attitudes questionnaire（ ITAQ）, medical outcome study short -form 36 -time questionnaire （SF- 36）, global assessment scale（GAS） and social disability screening schedule （SDSS）. Results ①The rate of discontinuation treatment due to any cause was 22.14% in combined treatment group and 45.71% in medication treatment alone group, and the difference between two groups was significant （P 〈0.01 ）. The rate of relapse was 11.43% in combined treatment group and 23.57% in medication treatment alone group, and the difference between two groups was significant （P 〈 0.05 ）. The rate of being hospitalized was 5.71% in combined treatment group and 15.8% in medication treatment alone group, the difference between the two groups was significant （P 〈 0.05 ）. The rate of drug compliance was 84.3 % in combined treatment group and 63.6% in medication treatment alone group, the difference between two groups was significant （P 〈 0.01 ）. ②Mean change of ITAQ scores was more in combined treatment than in medication treatment alone （P 〈 0.01 ）. Patients receiving combined treatment showed greater improvement in 7 domains of SF - 36. Mean change of SDSS and GAS score was more in combined treatment than in medication treatment alone （P 〈 0.01 ）. Conclusions In the first fall geriatric depression patients, antidepressants combination with psychosocial intervention is useful to prove insight and treatment adherence, quality of life and social function and prevent relapse.