CAJ | 학술논문

[目的]探讨“心境-促进协作医疗”（ IMPACT）管理模式对社区老年抑郁症患者疗效的影响。[方法]在上海市浦东新区精神卫生网络系统中，抽取符合病例要求的60例社区老年抑郁症患者，分为干预组和对照组，每组30例，干预组实施为期18个月的IMPACT管理治疗，对照组为常规的社区精神病康复管理。使用汉密尔顿抑郁量表（ HAMD）、抑郁自评量表（ SDS）和自知力与治疗态度问卷（ ITAQ）评价两组干预前与干预后第6、12、18个月时的抑郁症状及服药依从性得分变化情况，比较两组患者在干预期间的复发住院率。使用生活质量表（ SF-36）评价干预前、后（第18个月）两组患者的生存质量得分变化情况。[结果]在干预后第6、12、18个月，干预组患者的HAMD和SDS得分改善情况优于对照组（P均＜0．05），ITAQ得分提升高于对照组（P＜0．05）。 SF-36评价中，干预组患者的躯体疼痛、一般健康状况、精力、社会功能、精神健康及健康变化得分提升均优于对照组，两组差异有统计学意义（P均＜0．05）。干预组无1例复发住院，对照组有6例复发住院，复发住院率为20％（χ2＝6．67，P＜0．05）。[结论] IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状，降低复发住院率，改善老年抑郁症患者的生活质量。
[목적]탐토“심경-촉진협작의료”（ IMPACT）관리모식대사구노년억욱증환자료효적영향。[방법]재상해시포동신구정신위생망락계통중，추취부합병례요구적60례사구노년억욱증환자，분위간예조화대조조，매조30례，간예조실시위기18개월적IMPACT관리치료，대조조위상규적사구정신병강복관리。사용한밀이돈억욱량표（ HAMD）、억욱자평량표（ SDS）화자지력여치료태도문권（ ITAQ）평개량조간예전여간예후제6、12、18개월시적억욱증상급복약의종성득분변화정황，비교량조환자재간예기간적복발주원솔。사용생활질량표（ SF-36）평개간예전、후（제18개월）량조환자적생존질량득분변화정황。[결과]재간예후제6、12、18개월，간예조환자적HAMD화SDS득분개선정황우우대조조（P균＜0．05），ITAQ득분제승고우대조조（P＜0．05）。 SF-36평개중，간예조환자적구체동통、일반건강상황、정력、사회공능、정신건강급건강변화득분제승균우우대조조，량조차이유통계학의의（P균＜0．05）。간예조무1례복발주원，대조조유6례복발주원，복발주원솔위20％（χ2＝6．67，P＜0．05）。[결론] IMPACT관리모식능유효감경사구노년억욱증환자적억욱증상，강저복발주원솔，개선노년억욱증환자적생활질량。
To discuss the effectiveness of the IMPACT mode for late-life depression . [ Methods] From Shanghai Pudong mental health network system , 60 cases of elderly depressions were cho-sen according to the criteria for case reqirement .Of the 60 cases , 30 were allocated into the intervention group who were treated with 18 months'IMPACT.The other 30 were included in the control group , who were treated with routine management for psychiatric rehabilitation .Depressive symptoms and medication compli-ance scores were compared and assessed at 6,12 and 18 months before and after intervention by using the hamilton depression scale ( HAMD) , self-rating depression scale ( SDS ) and the insight and treatment atti-tude questionnaire ( ITAQ) .Comparison was also made in re-hospitalization during intervention between the two groups .The patients'quality of life was analyzed and compared between the two groups by 36-items short form health survey (SF-36). [Results] The HAMD and SDS scores in intervention group were signifi-cantly lower than those in control group at 6,12 and 18 months after intervention (Pall<0.05).ITAQ scores were higher than those in control group (P<0.05).According to the SF-36 scores, the bodily pain, general health, vitality, social functioning and mental health scores in intervention group were extremely higher than those in control group (Pall<0.05).There was not one case of recurrence in intervention group , however, there were 6 cases of recurrence in the control group , the recurrence hospitalization rate being 20%(χ2 =6.67, P<0.05). [Conclusion] IMPACT mode for late-life depression could relieve depressive symptoms effectively , thus reducing the recurrence hospitalization rate and improving the quality of life for patients .