摘要
目的探讨线上结构式团体认知行为治疗(internet-based structured group cognitive behavior therapy,I-GCBT)对轻症抑郁患者的有效性和可行性。方法使用SPSS20.0软件生成随机表,将96例轻症抑郁患者分配到线上视频团体干预组(线上组,n=64)与面对面干预组(线下组,n=32),使用HAMD17、HAMA、功能大体评定量表(Global Assessment of Functioning Scale,GAF)以及抑郁症状快速检查-自我报告评分16项(16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16)分别在基线、4周末、8周末和12周末评估患者抑郁、焦虑及整体功能水平。采用重复测量方差分析比较两组治疗效果差异,采用卡方检验比较两组脱落率、治愈率、治疗接受度差异。结果(1)2组患者基线HAMA评分差异有统计学意义(t=-2.08,P=0.04),其他基线数据差异无统计学意义。(2)对患者在组别和时间的交互作用分析显示,HAMD17、HAMA和QIDS-SR16的时间与组别交互作用均不显著(F=0.69,P>0.05;F=0.95,P>0.05;F=0.64,P>0.05),GAF的时间与组别交互作用显著(F=4.09,P<0.01),2组患者在各量表上时间主效应均显著(HAMD17:F=32.81,P<0.01;HAMA:F=20.86,P<0.01;GAF:F=105.98;P<0.01;QIDS-SR16:F=25.27,P<0.01)。12周末临床治愈率达62%(43/69),线上组57%(25/44),线下组72%(18/25),差异无统计学意义(χ^2=1.57,P=0.21)。(3)治疗期间总体脱落率为26%(21/81),线上组29%(15/51),线下组20%(6/30),2组比较差异无统计学意义(χ^2=0.87,P=0.35),患者对方案的接受程度达97%(58/60),线上组97%(35/36),线下组96%(23/24),2组比较差异无统计学意义(χ^2=0.09,P=0.78)。结论线上结构式团体认知行为治疗对轻症抑郁患者的疗效与面对面干预组相当,患者依从性较好。
Objective To explore the effectiveness and feasibility of internet-based structured group cognitive behavior therapy(I-GCBT)in patients with mild depressive disorder.Methods In this randomized controlled trial,based on a random number table which was generated from spss20.0,96 patients with mild depressive disorder were randomized to I-GCBT(n=64)and face-to-face group cognitive behavior therapy(GCBT,n=32).I-GCBT and GCBT patients were assessed by HAMD17,HAMA,Global Assessment of Functioning Scale,GAF and 16 Items Quick Inventory of Depressive Symptomatology-Self Report,QIDS-SR16 at baseline,4th week,8th week and 12th week.The differences between I-GCBT and GCBT were analyzed by repetitive measure analysis of variance and chi-square test.Results(1)There was no significant difference between I-GCBT and GCBT on demographics,duration of past depression history,baseline of HAMD17,GAF and QIDS-SR16,but a significantly higher HAMA seen in GCBT(t=-2.08,P=0.04).(2)The interaction of times and groups was significant in GAF(F=4.09,P<0.01)but not in HAMD17,HAMA and QIDS-SR16(F=0.69,P>0.05;F=0.95,P>0.05;F=0.64,P>0.05).In all measurement scales,Time main effects were significant(HAMD17:F=32.81,P<0.01;HAMA:F=20.86,P<0.01;GAF:F=105.98,P<0.01;QIDS-SR16:F=25.27,P<0.01).The symptoms remission rate of the overall patients was 62%(43/69)after 12 weeks treatment,lower in I-GCBT(57%,25/44)and higher in GCBT(72%,18/25).There was no significant difference between two groups(χ^2=1.57,P=0.21).(3)The overall dropout rate was 26%during the 12-weeks treatment specifically 29%(15/51)in I-GCBT and 20%(6/30)in GCBT without significant difference in-between(χ^2=0.87,P=0.35).97%(58/60)patients rated the treatment as acceptable(I-GCBT:97%(35/36),GCBT:96%(23/24)),and the difference of acceptability between two groups was not significant(χ^2=0.09,P=0.78).Conclusion The effectiveness and feasibility of I-GCBT are comparable to GCBT for mild depressive disorder.And the treatment adherence of I-GCBT seems good.
作者
畅临亚
丁菲
卢卫红
叶尘宇
薛莉莉
王宇
宋蕊
王琰
朱益
陶华
周慧鸣
方贻儒
苑成梅
Chang Linya;Ding Fei;Lu Weihong;Ye Chenyu;Xue Lili;Wang Yu;Song Rui;Wang Yan;Zhu Yi;Tao Hua;Zhou Huiming;Fang Yiru;Yuan Chengmei(Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Seventh Clinical Department,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200034,China;Department of Psychiatry,Zhongshan Hospital,Fudan University,Shanghai 200040,China;Department of Social Work,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China;Psychotherapy Department,Shanghai Hongkou Mental Health Center,Shanghai 200080,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 Jiaotong University School of Medicine,Shanghai 200030,China;Department of Clinical Psychology,Shanghai Mental Health Center,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)
出处
《中华精神科杂志》
CAS
CSCD
北大核心
2020年第1期35-41,共7页
Chinese Journal of Psychiatry
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)
上海市精神卫生中心睡眠障碍特色学科(2017-TSXK-02)
科技部"十二五"国家科技支撑项目(2012BAI01B04)
上海市科委医学引导项目(124119a8602)
上海交通大学"医工交叉研究基金"面上项目(YG2011MS37)
上海市卫生局公共卫生海外留学人才项目(GWHW201202)。
关键词
认知疗法
团体结构
抑郁
评价研究
可行性研究
Cognitive therapy
Group structure
Depression
Evaluation studies
Feasibility studies
