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(HA MD,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HA MD 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HA MD 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=4.121 P=0.042,χ²=4.586 P=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。

Objective

To investigate the effect of co mprehensive psychological inter vention on depression of patients after mastecto my.

Methods

A pr ospective casecontr ol single blind st udy was perf or med.Eighty seven fe male patients,who were postoperatively pat hol ogically confir med 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 eventuall y enr olled into statistical analysis,were divided into t he psychol ogical inter vention gr oup(n=46)and t he contr ol gr oup(n=41).Both groups were treated with sa me met hods,wit h no statistical diff erence in basic conditions bet ween the t wo groups.The control group received conventional treat ment and nursing care,and t he psychol ogical inter vention gr oup conventional treat ment and nursing care pl us co mprehensive psychol ogical inter vention.We used HA MD and t he Functional Assess ment of Cancer Therapy Scale-Breast(FACT-B)to assess t he depression degree and quality of life f or t hese patients bef ore t he inter vention and at t he end of the 4th week and the 6th month after the intervention.The co mpliance behaviors of patients were eval uated accor ding to t he dr opout rates of che mot herapy and radiot herapy.Repeated measures analysis of variance,chi-square test,t wo-sa mple t test and paired t test were used f or statistical analysis.

Results

There was a significant difference in HA MD score bet ween t he t wo 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 co mpared with before the intervention in theintervention group,and co mpared wit h t hose at the 6t h mont h in t he contr ol gr oup(P=0.000).The co mparison of t he dropout rates of postoperative chemotherapy and radiotherapy showed a statistical difference bet ween the t wo groups(χ²=4.121 P=0.042,χ²=4.586 P=0.032).

Conclusion

Co mprehensive psychological inter vention can significantly i mpr ove t he patient's mental healt h,treat ment co mpliance behavior and quality of life,so it is ver y suitable f or breast cancer patients after mastecto my.