轻症抑郁患者结构式团体认知行为治疗后的病耻感变化  

Self-stigma changes in patients with mild depression after structured group cognitive behavioral therapy

作　　者：卢静芳 畅临亚 王宇[2] 丁菲 卢卫红[4] 叶尘宇 薛莉莉[6] 宋蕊[2] 王琰[7] 陶华[8] 周慧鸣 葛方梅 李静茹 方贻儒[10] 苑成梅[11] LU Jingfang;CHANG Linya;WANG Yu;DING Fei;LU Weihong;YE Chenyu;XUE Lili;SONG Rui;WANG Yan;TAO Hua;ZHOU Huiming;GE Fangmei;LI Jingru;FANG Yiru;YUAN Chengmei(Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Psychotherapy De­partment,Shanghai Hongkou Mental Health Center,Shanghai 200080,China;Hangzhou Seventh People's Hospital,Hangzhou 310000,China;Seventh Clinical Department,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Department of Psychiatry,Zhongshan Hospital,Fudan University,Shanghai 200034,China;Department of Social Work,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Center of Disease Control,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Center of Disease Control,Shanghai Changning Mental Health Center,Shanghai 200050,China;Department of Psychiatry,Shanghai Changning Mental Health Center,Shanghai 200050,China;Department of Mood Disorder,Shanghai Mental Health Center,Shanghai Jiaolong University School of Medicine,Shanghai 200030,China;Department of Clinical Psychology,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030 [2]上海市虹口区精神卫生中心心理治疗科,上海200080 [3]杭州市第七人民医院,杭州310000 [4]上海交通大学医学院附属精神卫生中心临床七科,上海200030 [5]复旦大学附属中山医院心理医学科,上海200034 [6]上海交通大学医学院附属精神卫生中心社工部,上海200030 [7]上海交通大学医学院附属精神卫生中心疾控中心,上海200030 [8]上海市长宁区精神卫生中心疾控中心,上海200050 [9]上海市长宁区精神卫生中心精神科,上海200050 [10]上海交通大学医学院附属精神卫生中心心境障碍科,上海200030 [11]上海交通大学医学院附属精神卫生中心临床心理科,上海200030

出　　处：《中国心理卫生杂志》2021年第10期807-813,共7页Chinese Mental Health Journal

基　　金：上海市申康发展中心“适宜技术联合开发推广应用”项目(SHDC12016205);上海市申康发展中心重大临床研究项目-青年项目(SHDC2020CR4074);上海市精神卫生中心睡眠障碍特色学科(2017-TSXK-02);心身医学(2019ZB0201);上海市中医药事业发展三年行动计划(2018年-2020年)治未病服务重点推广项目(ZY(2018-2020)-ZWB-1001-FWB-07);上海市科委科技创新行动计划(20Y11906600)

摘　　要：目的:考察接受线上-线下结构式团体认知行为治疗方案(I-GCBT)的轻症抑郁患者病耻感的变化。方法:本文采用随机对照设计,将符合入组标准的119名轻症抑郁患者[17条目汉密顿抑郁量表(HAMD-17)分≥8分且≤17分],随机分配到线上视频团体干预组(线上视频组)与线下面对面团体干预组(线下对照组),每组均给予每周1次、每次90 min共12次的团体认知行为治疗;于基线、治疗4周、8周和12周末进行精神疾病患者病耻感量表(SSMI-C)评估。结果:共77例患者完成基线后至少一次随访(线上视频组50例,线下对照组27例)。两组的基线HAMD-17总分、SSMI-C总分及3个因子分差异均无统计学差异(均P>0.05)。经过12周治疗后,两组的SSMIC总分及歧视、病情掩饰因子分均降低(均P<0.01),线下对照组的歧视、病情掩饰因子分在4周末时出现降低(P<0.05或P<0.01),线上视频组的歧视、病情掩饰因子分在12周末时出现降低(均P<0.01)。结论:结构式团体认知行为治疗可有效改善轻症抑郁患者病耻感,线下干预形式可较早改善患者的被歧视感和病情掩饰,线上干预形式具有一定推广应用价值。Objective:To investigate the self-stigma changes in patients with mild depression after internet-based structured group cognitive behavioral therapy(I-GCBT).Methods:In a randomized controlled design,119 patients with mild depression[17-item Hamilton Depression Scale(HAMD-17)scores≥8 and≤17]were ran­domly assigned to online video intervention group(online video group)and face-to-face intervention group(face-to-face control group).Each group was given group cognitive behavior therapy once a week,90 minutes each time,a total of 12 times.They were assessed with the Stigma Scale for Mental Illness-Chinese(SSMI-C)at baseline,4 weeks,8 weeks and 12 weeks of treatment.Results:Totally 77 patients with mild depression completed at least one follow-up after baseline and were included in the valid data set(50 in the I-GCBT group and 27 in the GCBT group).There were no significant differences on demographics,baseline of HAMD-17,SSMI-C and its three factors between the groups(Ps>0.05).After the 12-week treatment,the scores of SSMI-C,discrimination factor and dis­ease concealment factor were significantly decreased(Ps<0.01)in both groups.The scores of discrimination and disease concealment factors in the GCBT group decreased significantly after the 4-week treatment(P<0.05 or P<0.01).The scores of discrimination and disease concealment factors in the I-GCBT group decreased significantly af­ter the 12-week treatment(P_(s)<0.01).Conclusion:Structured group cognitive behavior therapy could effectively improve the stigma experience of mild depression patients.Face-to-face treatment could reduce the scores of dis­crimination factor and disease concealment factor earlier,and online therapy has certain popularization and applica­tion value.

关 键 词：线上 团体认知行为治疗 轻症抑郁 病耻感 

分 类 号：R749.41[医药卫生—神经病学与精神病学] R749.059[医药卫生—临床医学]