【摘要】 目的押从患者角度探讨影响抑郁症患者治疗依从性的因素。方法:收集2003-07/2004-05大连医科大学附属第一医院神经内科抑郁专家门诊及住院患者128例。全部患者均为首次接受治疗,符合DSM-Ⅳ重症抑郁单次发作诊断标准,排除伴有严重精神病性症状者、双相障碍者、合并严重器质性疾病不能随访者。2005-06对患者进行电话随访,跟踪研究,询问其自然情况穴如性别,年龄,文化程度,家庭经济情况雪,诊断认可情况,停止治疗的主要原因。填写自制登记表格,停止治疗原因采用频数分析熏对自然情况及停止治疗原因进行回顾性研究,分析各因素与依从性的相关性熏各因素与家庭支持的关系熏分析方法采用回归分析。结果:19例患者电话变更失访,109例患者进入结果分析,随访率85.2%。①109例抑郁症患者至电话随访调查时脱落70例,脱落率64.2%。37.6%的患者1个月内脱落,56.0%的患者3个月内脱落。其中1个月内脱落者41例熏而28例患者(25.7%)于治疗最初2周内脱落;1～3个月脱落者20例(18.4%);3～6个月脱落7例(6.4%);6～9个月脱落者1例(0.9%);9～12个月脱落者1例(0.9%)。②第1个月停止治疗原因与药物副作用及治疗无效有关,3～6个月停止治疗的主要原因较复杂,与经济困难及治疗好转,治疗无效均有关,6个月以上停止治疗原因为治疗好转。③以脱落为因变量,年龄、家庭支持、性别、经济情况、疾病认同情况、受教育程度等为自变量进行多因素分析。多因素分析示家庭支持(P<0.05)及年龄(P<0.01)与脱落相关。脱落与性别无关。④以家庭支持关系为因变量,以疾病认同、性别、受教育程度及经济情况为自变量进行回归分析。显示家庭对治疗的支持是由家庭内部的多种因素决定的,包括家庭对疾病的认同,受教育程度及家庭经济情况。结论:抑郁症患者依从性与多方面因素相关,且各因素间相互作用,相互影响,治疗无效及药物副作用是急性期治疗脱落的主要原因,对治疗持续性的不理解是维持期治疗脱落的原因。认可疾病熏受教育程度高熏经济条件好者不易脱落。更多还原

【Abstract】 AIM: To investigate relative factors those affect the treatment compliance in patients with depression from the field of patient.METHODS: Totally 128 patients with depression who were collected from expert’s out-patient clinic and inpatient of Department of Neurology, First Affiliated Hospital, Dalian Medical University from July 2003 to May 2004. The patients were treated firstly, and consistent with DSM-Ⅳ. Those who accompanied severe psychiatric symptom, double disorder and organic disease were excluded. The patients were followed up by phone in June 2005, asked about their natural conditions (such as sex, age, education, family economy), ratified state and the cause of discontinued treatment. The patients filled in the self-administered questionnaire. The cause of discontinued treatment was analyzed by frequency. The natural condition and the cause of discontinued treatment were researched in retrospective analysis. The relation between the faction and compliance as well as between the faction and family support were analyzed by regression analysis. RESULTS: A total of 19 patients drop out because telephone modification, so 109 patients were involved in the result analysis with the follow-up rate of 85.2%. Of the 109 patients with depression, 70 patients dropped out in the phone follow-up with the expulsion rate of 64.2%. 37.6% of patients stopped being treated in the first month, 56.0% stopped in the third month. Forty-one patients dropped out in the first month, 28(25.7%) patients dropped out in the first 2 weeks. Twenty patients (18.4%) dropped out in 1-3 months. Seven patients (6.4%) dropped out in 3-6 months. One patient (0.9%) dropped out in 6-9 months and one patient (0.9%) dropped out in 9-12 months. ②The major causes of discontinued treatment as prescribed after only 1-month was lack of inefficacy or adverse events. The major cause of discontinued treatment from 3-6 months was complicated, which were associated with difficult economy, improved management and ineffective treatment. The cause of discontinued treatment over 6 months was improved management. ③Taking drop out as dependent variable and taking age, family support, sex, economy, disease identification and education as independent variable to perform multivariate analysis. Multivariate analysis showed that family support (P < 0.05) and age (P < 0.01) were associated with drop out, and drop out was not associated with sex. ④Taking family support as dependent variable, taking disease identification, sex, education and economy as independent variable to perform regression analysis. It showed that the support of family to treatment was determined by many factors of internal family, including the disease identification, education and family economy. CONCLUSION: Compliance and multivariate factors are reacted and influence each other in patients with depression. Inefficacy or adverse events are the main cause of drop out with acute therapy. The misunderstanding of continued treatment is the cause of drop out in maintenance period. Patients with disease identification, high education and well economy are not easy to drop out.更多还原