系统心理干预在缓解阿尔茨海默病患者照顾者抑郁症状中的实践
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摘要
目的 :分析系统心理干预对阿尔茨海默病(Alzheimer's Disease,AD)患者照顾者抑郁症状的缓解作用。方法 :选择既往在我院就诊并符合AD诊断标准的患者照顾者80例进行SCL-90、SDS、LES、HADM 4个量表评估,通过3次筛选,将有抑郁症的照顾者随机分为干预组(n=40)和对照组(n=40),对干预组进行系统的心理干预治疗,干预2个月后对两组研究对象进行SCL-90、SDS、LES、HADM 4个量表的测试,收集数据进行分析。结果:干预前,对照组和干预组的SCL-90、SDS、LES、HADM评分无统计学差异(P>0.05);干预后,干预组的量表评分均低于对照组(P均<0.05)。结论 :对阿尔茨海默病患者的照顾者进行全面系统的心理干预,有利于缓解其抑郁症状,是具有可操作性的心理干预措施,应该延伸至社区。
Objective:To investigate the effect of comprehensive and systematic interventions on depressive symptoms of caregivers of patients with Alzheimer's Disease.Methods:80 caregivers of patients with Alzheimer's Disease from tertiary hospitals in Kunming were chosen and randomly divided into the control group(n=40) and the experimental group(n=40).Basic interventions,thematic interventions and short-term group CBT were provided for each patient in the experimental group,while no specific training was supplied to the control group.2 months after the intervention,all subjects were evaluated through scales including SCL-90,SDS,LES and HADM.Results:After the intervention,scores of SCL-90,SDS,LES,and HADM of the two groups both decreased significantly(P<0.05).The scores of SCL-90,SDS,LES,and HADM of the experimental group were lower than those of the control group(P<0.05).Conclusion:The comprehensive and systematic intervention could effectively alleviate depressive symptoms of caregivers of patients with Alzheimer's Disease.We suggest the comprehensive intervention should be applied widely to the community.
Objective:To investigate the effect of comprehensive and systematic interventions on depressive symptoms of caregivers of patients with Alzheimer's Disease.Methods:80 caregivers of patients with Alzheimer's Disease from tertiary hospitals in Kunming were chosen and randomly divided into the control group(n=40) and the experimental group(n=40).Basic interventions,thematic interventions and short-term group CBT were provided for each patient in the experimental group,while no specific training was supplied to the control group.2 months after the intervention,all subjects were evaluated through scales including SCL-90,SDS,LES and HADM.Results:After the intervention,scores of SCL-90,SDS,LES,and HADM of the two groups both decreased significantly(P<0.05).The scores of SCL-90,SDS,LES,and HADM of the experimental group were lower than those of the control group(P<0.05).Conclusion:The comprehensive and systematic intervention could effectively alleviate depressive symptoms of caregivers of patients with Alzheimer's Disease.We suggest the comprehensive intervention should be applied widely to the community.
引文
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[9]李伟梅.阿尔茨海默病患者功能障碍与家庭照护者负担的相关性.中国现代医生,2015,53(17):138-139.Li W M.Correlation between functional impairment of Alzheimer's disease patients and family caregivers'burden.China Modern Doctor,2015,53(17):138-139.
[10]罗平,谭小林,陈非,等.阿尔茨海默病性痴呆患者的照料者负担及其影响因素调查.现代医药卫生,2015,31(6):837-840.Luo P,Tan XL,Chen F,et al.Survey on burdens and its inf luencing factors of caregivers of Alzheimer′s dementia.Journal of Modern Medicine&Health,2015,31(6):837-840.
[11]Van Mierlo LD,Meiland FJM,Van der Roest HG,et al.Personalised caregiver support:effectiveness of psychosocial interventions in subgroups of caregivers of people with dementia.International Journal of Geriatric Psychiatry,2012,27(1):1-14.
[12]Arango-Lasprilla JC,Panyavin I,Merchán EJH,et al.Evaluation of a Group CognitiveBehavioral dementia caregiver intervention in Latin America.American Journal of Alzheimer's Disease and Other Dementias,2014,29(6):548-555.
[13]Pitteri F,Soulas T,Essertaise AL,et al.Contribution of relaxation to a psychoeducational intervention program for family carers of persons with Alzheimer's disease.Geriatrieet Psychologie Neuropsychiatrie du Vieillissement,2013,11(4):443-451.
[14]Passoni S,Moroni L,Toraldo A,et al.Cognitive behavioral group intervention for Alzheimer caregivers.Alzheimer Disease&Associated Disorders,2014,28(3):275-282.
[15]吕红红.健康教育对老年痴呆患者家属心理健康及应付方式的影响.护理与康复,2010,9(4):364-365.Lyu HH.The effect of ental health and the health education on senile dementia patients'families cope with the way.Nursing and Rehabilitation Journal,2010,9(4):364-365.
[16]周园园,谈晓芳,沈丽珍.心理干预对改善抑郁症患者家属心理状况的效果分析.中国健康心理学杂志,2012,20(9):1364-1365.Zhou YY,Tan XF,Shen LZ.Effects of the psychological intervention on improving the psychological state of family members of patients with depression.China Journal of Health Psychology,2012,20(9):1364-1365.
[17]刘倩,曹素霞,庞剑月,等.短程团体认知行为疗法治疗抑郁症的疗效观察.中华行为医学与脑科学杂志,2016(10):896-899.Liu Q,Cao SX,Pang JY,et al.Effect of short-term group cognitive behavioral therapy in patients with major depressive disorder.Chinese Journal of Behavioral Medicine and Brain Science,2016(10):896-899.
[18]张博元,丁雪凡,卢卫红,等.团体认知行为治疗对轻度抑郁症患者生活质量及社会功能的作用.上海精神医学,2016,28(1):18-27.Zhang BY,Ding XF,Lu WH,et al.Effect of group cognitve-behavioral therapy on the quality of life and social funcitoning of paitents with mild depression.Shanghai Archives of Psychiatry,2016,28(1):18-27.
[19]Hans E,Hiller W.Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression:a metaanalysis of nonrandomized effectiveness studies.J Consult Clin Psychol,2013,81(1):75-88.
[20]廖淑莉,吴洁梅.认知行为治疗在护理阿尔茨海默病患者中的应用.中国临床护理,2015,7(3):236-237.Liao SL,Wu JM.Application of cognitive behavioral therapy in senile dementia patients.Chinese Clinical Nursing,2015,7(3):236-237.
[21]于相芬.心理干预对老年期痴呆患者亲属心理健康状况的影响.精神医学杂志,2011,24(1):43-45.Yu XF.The effects of psychological intervention on mental healthy status in relatives of patients with senile dementia.Journal of Psychiatry,2011,24(1):43-45.
[22]李华,常亭玲,孙谷珍,等.支持性心理干预对住院老年痴呆患者监护人焦虑抑郁的改善作用.护理学杂志,2013,28(19):74-75.Li H,Chang TL,Sun GZ,et al.Effect of supportive psychological interventions on anxiety and depression levels of custodians of senile dementia inpatients.Journal of Nursing Science,2013,28(19):74-75.
[23]赵岩,张丹丹,赵亚利,等.综合干预对老年痴呆患者家庭照顾者抑郁情绪改善的系统评价.中国全科医学,2015(35):4349-4353.Zhao Y,Zhang DD,Zhao YL,et al.Systematic review of effect of comprehensive intervention on depression of family caregivers of patients with senile dementia.Chinese General Practice,2015(35):4349-4353.
[24]熊丽娜,金燕飞,金昌德.阿尔茨海默病患者家属心理干预研究现状.中国护理管理,2015,15(2):250-253.Xiong LN,Jin YF,Jin CD.The research progress of psychological intervention among family members of Alzheimer's disease patients.Chinese Nursing Management,2015,15(2):250-253.
[2]徐娜,金奕,刘莹,等.医院社区家庭延续护理对阿尔茨海默病病人生活质量的影响.护理研究,2016,30(21):2615-2618.Xu N,Jin Y,Liu Y,et al.Influence of hospital community family continuing care on qual ity of l ife of patients with Alzheimer's disease.Chinese Nursing Research,2016,30(21):2615-2618.
[3]李霞,马莉.阿尔茨海默病患者精神行为症状的家庭干预策略.中国护理管理,2016,16(1):129-132.Li X,Ma L.Family intervention of behavioral and psychological symptoms of Alzheimer's Disease.Chinese Nursing Management,2016,16(1):129-132.
[4]杨桂华,常宗霞,焦琳琳,等.阿尔茨海默病照顾者的心理干预研究进展.中华护理教育,2015,12(1):74-78.Yang GH,Chang ZX,Jiao LL,et al.Research progress of psychological intervention among caregivers of Alzheimer's disease patients.Chinese Journal of Nursing Education,2015,12(1):74-78.
[5]陈树林,李凌江.SCL90信度效度检验和常模的再比较.中国神经精神疾病杂志,2003,29(5):323-324.Chen SL,Li LJ.SCL90 reliability validity test and norm comparison.Journal of Chinese Neuropsychiatric Disease,2003,29(5):323-324.
[6]舒良.自评抑郁量表.中国心理卫生杂志,1999(增刊):194-196.Shu L.Self-rating depression scale.Chinese Journal of Mental Health,1999(增刊):194-196.
[7]张亚林,杨德森.生活事件量表.中国心理卫生杂,1993(增刊):101-106.Zhang YL,Yang DS.Life event scale.Chinese Journal of Mental Health,1993(增刊):101-106.
[8]汤毓华.汉密尔顿抑郁量表.中国心理卫生杂,1999(增刊):220-223.Tang YH.Hamilton depression scale.Chinese Journal of Mental Health,1999(增刊):220-223.
[9]李伟梅.阿尔茨海默病患者功能障碍与家庭照护者负担的相关性.中国现代医生,2015,53(17):138-139.Li W M.Correlation between functional impairment of Alzheimer's disease patients and family caregivers'burden.China Modern Doctor,2015,53(17):138-139.
[10]罗平,谭小林,陈非,等.阿尔茨海默病性痴呆患者的照料者负担及其影响因素调查.现代医药卫生,2015,31(6):837-840.Luo P,Tan XL,Chen F,et al.Survey on burdens and its inf luencing factors of caregivers of Alzheimer′s dementia.Journal of Modern Medicine&Health,2015,31(6):837-840.
[11]Van Mierlo LD,Meiland FJM,Van der Roest HG,et al.Personalised caregiver support:effectiveness of psychosocial interventions in subgroups of caregivers of people with dementia.International Journal of Geriatric Psychiatry,2012,27(1):1-14.
[12]Arango-Lasprilla JC,Panyavin I,Merchán EJH,et al.Evaluation of a Group CognitiveBehavioral dementia caregiver intervention in Latin America.American Journal of Alzheimer's Disease and Other Dementias,2014,29(6):548-555.
[13]Pitteri F,Soulas T,Essertaise AL,et al.Contribution of relaxation to a psychoeducational intervention program for family carers of persons with Alzheimer's disease.Geriatrieet Psychologie Neuropsychiatrie du Vieillissement,2013,11(4):443-451.
[14]Passoni S,Moroni L,Toraldo A,et al.Cognitive behavioral group intervention for Alzheimer caregivers.Alzheimer Disease&Associated Disorders,2014,28(3):275-282.
[15]吕红红.健康教育对老年痴呆患者家属心理健康及应付方式的影响.护理与康复,2010,9(4):364-365.Lyu HH.The effect of ental health and the health education on senile dementia patients'families cope with the way.Nursing and Rehabilitation Journal,2010,9(4):364-365.
[16]周园园,谈晓芳,沈丽珍.心理干预对改善抑郁症患者家属心理状况的效果分析.中国健康心理学杂志,2012,20(9):1364-1365.Zhou YY,Tan XF,Shen LZ.Effects of the psychological intervention on improving the psychological state of family members of patients with depression.China Journal of Health Psychology,2012,20(9):1364-1365.
[17]刘倩,曹素霞,庞剑月,等.短程团体认知行为疗法治疗抑郁症的疗效观察.中华行为医学与脑科学杂志,2016(10):896-899.Liu Q,Cao SX,Pang JY,et al.Effect of short-term group cognitive behavioral therapy in patients with major depressive disorder.Chinese Journal of Behavioral Medicine and Brain Science,2016(10):896-899.
[18]张博元,丁雪凡,卢卫红,等.团体认知行为治疗对轻度抑郁症患者生活质量及社会功能的作用.上海精神医学,2016,28(1):18-27.Zhang BY,Ding XF,Lu WH,et al.Effect of group cognitve-behavioral therapy on the quality of life and social funcitoning of paitents with mild depression.Shanghai Archives of Psychiatry,2016,28(1):18-27.
[19]Hans E,Hiller W.Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression:a metaanalysis of nonrandomized effectiveness studies.J Consult Clin Psychol,2013,81(1):75-88.
[20]廖淑莉,吴洁梅.认知行为治疗在护理阿尔茨海默病患者中的应用.中国临床护理,2015,7(3):236-237.Liao SL,Wu JM.Application of cognitive behavioral therapy in senile dementia patients.Chinese Clinical Nursing,2015,7(3):236-237.
[21]于相芬.心理干预对老年期痴呆患者亲属心理健康状况的影响.精神医学杂志,2011,24(1):43-45.Yu XF.The effects of psychological intervention on mental healthy status in relatives of patients with senile dementia.Journal of Psychiatry,2011,24(1):43-45.
[22]李华,常亭玲,孙谷珍,等.支持性心理干预对住院老年痴呆患者监护人焦虑抑郁的改善作用.护理学杂志,2013,28(19):74-75.Li H,Chang TL,Sun GZ,et al.Effect of supportive psychological interventions on anxiety and depression levels of custodians of senile dementia inpatients.Journal of Nursing Science,2013,28(19):74-75.
[23]赵岩,张丹丹,赵亚利,等.综合干预对老年痴呆患者家庭照顾者抑郁情绪改善的系统评价.中国全科医学,2015(35):4349-4353.Zhao Y,Zhang DD,Zhao YL,et al.Systematic review of effect of comprehensive intervention on depression of family caregivers of patients with senile dementia.Chinese General Practice,2015(35):4349-4353.
[24]熊丽娜,金燕飞,金昌德.阿尔茨海默病患者家属心理干预研究现状.中国护理管理,2015,15(2):250-253.Xiong LN,Jin YF,Jin CD.The research progress of psychological intervention among family members of Alzheimer's disease patients.Chinese Nursing Management,2015,15(2):250-253.