问题解决疗法对首发中重度抑郁症患者抑郁症状和认知灵活性的影响

范亚丹; 陈晶; 余小定; 罗萍

doi:10.16766/j.cnki.issn.1674-4152.003845

问题解决疗法对首发中重度抑郁症患者抑郁症状和认知灵活性的影响

doi: 10.16766/j.cnki.issn.1674-4152.003845

范亚丹^1, ,,
陈晶²,
余小定¹,
罗萍¹

1.
绍兴市第七人民医院心身障碍科二病区(睡眠病区)，浙江绍兴 312000
2.
绍兴市第七人民医院普通精神科三病区

基金项目:

浙江省医药卫生科技计划项目 2023KY1272

详细信息

通讯作者:
范亚丹，E-mail：fanhushi83@163.com

中图分类号: R749.4
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- 文章访问数: 29
- HTML全文浏览量: 20
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2024-08-19
- 网络出版日期: 2025-02-13

The effect of problem-solving therapy on depressive symptoms and cognitive flexibility in patients with primary moderate to severe depression

1.
Department 2 of Psychosomatic Disorders, Shaoxing Seventh People' s Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的分析在常规护理基础上应用问题解决疗法干预在首发抑郁症患者中的应用效果，及对患者抑郁症状和认知灵活性的影响。方法选取2021年2月—2023年10月绍兴市第七人民医院收治的126例首发中重度抑郁症患者作为研究对象，采用随机数字表法将其分为对照组(63例)和观察组(63例)。对照组应用常规护理，观察组在对照组基础上应用问题解决疗法。比较2组患者干预前后抑郁症状[汉密尔顿抑郁量表24项(HAMD-24)]及认知灵活性[认知灵活性问卷(CFI)]。结果干预后，2组患者HAMD-24量表评分中各维度及总分均较干预前有所降低，观察组总分为(17.84±2.73)分，明显低于对照组[(20.15±3.16)分]，差异有统计学意义(P < 0.05)；干预后，观察组患者CFI量表中可选择性、可控性及总分分别为(51.81±6.22)分、(18.91±2.74)分、(71.31±7.40)分，均高于对照组[(42.53±4.37)分、(15.72±2.83)分、(60.22±6.83)分]，差异均有统计学意义(P < 0.05)。结论问题解决疗法能在常规治疗及护理的基础上改善首发中重度抑郁症患者抑郁症状，提高患者认知灵活性，具有一定的临床价值。
- 首发抑郁症 /
- 问题解决疗法 /
- 抑郁症状 /
- 认知灵活性
Abstract: Objective To analyze the application effect of problem-solving therapy intervention on the basis of routine nursing in patients with first-episode depression, and its impact on patients' depressive symptoms and cognitive flexibility. Methods A total of 126 patients with first-episode moderate to severe depression admitted to the Seventh People' s Hospital of Shaoxing City from February 2021 to October 2023 were selected as the study subjects, and they were divided into the control group (63 cases) and the observation group (63 cases) according to the method of randomized numerical table. The control group accepted routine nursing intervention, while the observation group accepted problem-solving therapy nursing on the basis of the control group. The depressive symptoms [Hamilton depression scale-24 items (HAMD-24)] and cognitive flexibility [cognitive flexibility inventory (CFI)] were compared between two groups of patients. Results After the intervention, the scores of each dimension and total score in the HAMD-24 scale of the two groups of patients decreased compared to before the intervention, and the total score of the observation group was (17.84±2.73) points, clearly less than that of the control group [(20.15±3.16) points], with statistical significance (P < 0.05). After intervention, the selectivity, controllability, and total score of the CFI scale in the observation group were (51.81±6.22) points, (18.91±2.74) points, and (71.31±7.40) points, respectively, which were higher than those in the control group [(42.53±4.37) points, (15.72±2.83) points, and (60.22±6.83) points], with statistical significance (P < 0.05). Conclusion Problem solving therapy nursing can improve the depressive symptoms and cognitive flexibility of first-onset moderate to severe depression patients on the basis of routine treatment and nursing, and has certain clinical value.
- First-onset depression /
- Problem solving therapy /
- Depression symptoms /
- Cognitive flexibility

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图 1 PST实施流程

Figure 1. PST Implementation Process

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表 1 2组抑郁症患者一般情况比较

Table 1. Comparison of the general information between two groups of depression patients

项目	对照组(n=63)	观察组(n=63)	统计量	P值
性别(例)			0.835^a	0.361
男性	22	27
女性	41	36
年龄(x±s，岁)	38.42±8.16	37.91±7.49	0.365^b	0.715
文化水平(例)			1.303^c	0.521
初中及以下	7	5
中专/高中	22	28
大专及以上	34	30
经济水平(例)			0.493^c	0.782
较好	22	25
一般	33	32
困难	8	6
病程时间(x±s，月)	10.76±3.58	11.01±4.12	0.364^b	0.717
抑郁程度(例)			0.904^a	0.342
中度	40	45
重度	23	18
艾司西酞普兰用量(x±s，mg)	15.63±3.11	15.70±2.24	0.145^b	0.885
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组抑郁症患者抑郁症状得分比较(x±s，分)

Table 2. Comparison of depression symptom scores between two groups of patients(x±s, points)

组别	例数	认知障碍		迟缓		绝望感		体重变化
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	9.87±1.14	6.05±1.04^b	8.76±1.36	3.13±1.25^b	6.95±1.52	2.44±0.51^b	2.14±0.60	1.87±0.42
观察组	63	10.01±1.33	4.21±0.78^b	8.88±1.41	2.72±0.77^b	7.02±2.03	1.57±0.23^b	2.20±0.55	1.86±0.38
统计量		0.634^a	9.382^c	0.486^a	2.201^c	0.219^a	10.793^c	1.268^a	0.152^c
P值		0.527	< 0.001	0.628	0.032	0.827	< 0.001	0.207	0.834

组别	例数	焦虑/躯体化		日夜变化		睡眠障碍		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	12.31±1.56	4.03±1.24^b	1.75±0.39	0.94±0.35^b	5.10±1.00	2.22±0.34^b	29.83±4.55	20.15±3.16^b
观察组	63	12.38±2.11	2.51±0.78^b	1.81±0.46	0.76±0.22^b	5.04±1.17	1.65±0.26^b	30.13±3.81	17.84±2.73^b
统计量		0.212^a	6.966^c	0.790^a	3.156^c	0.309^a	9.873^c	0.401^a	4.247^c
P值		0.833	< 0.001	0.431	0.002	0.758	< 0.001	0.689	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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表 3 2组抑郁症患者认知灵活性得分对比(x±s，分)

Table 3. Comparison of cognitive flexibility scores between two groups of depressed patients (x±s, points)

组别	例数	可选择性		可控性		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	63	34.18±5.70	42.53±4.37^b	15.81±2.66	15.72±2.83	51.28±7.46	60.22±6.83^b
观察组	63	34.52±5.22	51.81±6.22^b	16.02±3.11	18.91±2.74^b	51.42±8.15	71.31±7.40^b
统计量		0.349^a	8.793^c	0.407^a	5.922^c	0.101^a	8.031^c
P值		0.728	< 0.001	0.684	< 0.001	0.920	< 0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP < 0.05。

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