抑郁患者不良情绪预防与管理的最佳证据研究

俞晓炜; 李松涛; 宣月红; 姚秋女

doi:10.16766/j.cnki.issn.1674-4152.003927

抑郁患者不良情绪预防与管理的最佳证据研究

doi: 10.16766/j.cnki.issn.1674-4152.003927

1.
绍兴市第七人民医院精二病区，浙江绍兴 312000
2.
绍兴市第七人民医院精神二科

基金项目:

浙江省医药卫生科技计划项目 2024KY1735

详细信息

通讯作者:
俞晓炜，E-mail：yuj997@126.com

中图分类号: R749.05 R395.6
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-27
- 网络出版日期: 2025-05-14

The best evidence study on the prevention and management of bad mood in depressed patients

1.
Jing ' er Ward of Shaoxing Seventh People ' s Hospital, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的检索和分析抑郁症患者焦虑和抑郁管理的相关证据，并对最佳证据进行总结。方法本研究选择“抑郁症、不良情绪、管理、预防”作为中文关键词，对应的英文关键词为“Depression, Bad mood, Management, Prevention”。计算机检索英国国家临床医学研究所指南库、美国指南网、UptoDate、PubMed等数据库中关于抑郁症患者不良情绪预防与管理的指南、专家共识、推荐实践和系统评价。检索时限为建库至2022年3月20日，根据原始文献的类型(指南、专家共识以及系统评价)选择相应的评估标准，应用内容分析法整合纳入的文献，提取和汇总符合质量标准的文献。结果本次研究最终从664篇文献中纳入12篇文献，其中指南与专家共识各3篇、系统评价6篇，且质量评估结果均合格。本研究汇总了抑郁患者不良情绪的预防与管理的筛查、预防、危险因素、治疗及健康宣教5个方面的证据，经过最终筛选获得15条最佳证据。结论抑郁患者不良情绪的预防与管理的最佳证据可以为医护人员提供循证证据。医护人员应根据临床具体情况和患者特点制定预防与管理措施，并应用最佳证据以更系统、科学的方法管理抑郁患者不良情绪，提高护理质量。
- 抑郁症 /
- 不良情绪 /
- 预防 /
- 管理 /
- 最佳证据
Abstract: Objective To retrieve and analyze relevant evidence on the management of anxiety and depression management in patients with depression, and to summarize the best evidence. Methods In this study, "Depression, Bad mood, Management, Prevention" was selected as the Chinese keyword, and the corresponding English keyword was "depression, bad mood, management, prevention". The guidelines, expert consensus, recommended practice, and systematic review on the prevention and management of bad mood in patients with depression were searched by computer from the National Institute of Clinical Medicine Guideline database, US guide.com, UptoDate, PubMed and other databases. The search period was from the establishment of the database to March 20, 2022. The corresponding evaluation criteria were selected according to the type of original literature (guidelines, expert consensus and systematic review), the included literature was integrated by content analysis method, and the literature meeting the quality standards was extracted and summarized. Results In this study, 12 literatures were finally included from 664 literatures, including 3 guidelines, 3 expert consensus, and 6 systematic reviews, and the quality assessment results were all qualified. The evidence from five aspects of screening, prevention, risk factors, treatment and health education for the prevention and management of negative emotions in depressed patients was summarized, and 15 pieces of best evidence were obtained after final screening. Conclusion The best evidence on the prevention and management of bad mood in patients with depression can provide evidence-based evidence for medical staff. Medical staff should formulate prevention and management measures according to the specific clinical situation and characteristics of patients, and apply the best evidence to manage the bad mood of patients with depression in a more systematic and scientific way, so as to improve the quality of nursing.
- Depression /
- Bad mood /
- Prevention /
- Management /
- Best evidence

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表 1 纳入研究的基本特征

Table 1. Basic features of included studies

纳入研究	研究来源	研究性质	研究标题	发表年份
中华医学会等^[7]	中国知网	指南	抑郁症基层诊疗指南	2021
许秀峰等^[8]	中国知网	指南	抑郁症的多学科协同治疗	2013
STAHL S M, et al^[9]	Pubmed	指南	抑郁症的识别和管理指南	2017
中华医学会精神医学分会抑郁障碍研究协作组^[10]	中国知网	专家共识	抑郁症认知症状评估与干预专家共识	2020
SAKURAI H, et al^[11]	Pubmed	专家共识	抑郁症的药物治疗专家共识	2020
MCALLISTER-WILLIAMS R H, et al^[12]	Pubmed	专家共识	难治性抑郁症的识别、评估和管理：国际共识声明	2020
KVERNO K S, et al^[13]	Pubmed	系统评价	难治性抑郁症的治疗方法。	2021
CLADDER-MICUS M B, et al^[14]	Pubmed	系统评价	正念认知疗法的应用	2018
GAYNES B^[15]	Pubmed	系统评价	难治性抑郁症的危险因素	2016
RIBEIRO J D, et al^[16]	Pubmed	系统评价	抑郁和绝望是自杀意念、企图和死亡的危险因素：纵向研究的荟萃分析	2018
BUCKMAN J E J, et al^[17]	Pubmed	系统评价	抑郁症复发和复发的危险因素	2018
田德财等^[18]	中国知网	系统评价	抑郁症的筛查以及应用量表	2011

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表 2 指南的评估结果

Table 2. Results of the evaluation of the guidelines

纳入文献	各领域标准化百分比(%)						≥60%的领域数	≤30%的领域数	推荐级别(级)
纳入文献	范围和目的	参与人员	制定的严谨性	表达的明晰性	应用性	编辑的独立性	≥60%的领域数	≤30%的领域数	推荐级别(级)
中华医学会等^[7]	100.00	54.17	76.19	83.33	50.00	85.71	4	0	B
许秀峰等^[8]	83.33	50.00	42.86	91.67	55.56	41.67	2	0	B
STAHL S M, et al^[9]	100.00	70.83	76.19	77.78	62.50	83.33	6	0	A

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表 3 系统评价的评估结果

Table 3. Evaluation results of systematic evaluation

研究内容	1	2	3	4	5	6	7	8	9	10	11
KVERNO K S, et al^[13]	是	是	是	是	是	是	是	是	是	是	是
CLADDER-MICUS M B, et al^[14]	是	是	是	是	不清楚	是	是	是	是	是	是
GAYNES B^[15]	是	是	是	是	是	是	不清楚	是	是	是	是
RIBEIRO J D, et al^[16]	是	是	是	是	是	是	是	是	不清楚	是	是
BUCKMAN J E J, et al^[17]	是	是	是	是	是	是	不清楚	是	是	是	不清楚
田德财等^[18]	是	是	是	是	是	是	是	是	不清楚	是	是

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表 4 抑郁患者不良情绪的预防与管理的最佳证据总结

Table 4. Summary of best evidence on prevention and management of adverse mood in depressed patients

主题	证据内容	证据等级	推荐轻度
危险因素	1.危险因素包括年龄(＜70岁)、抑郁家族史、脑卒中、既往抑郁史、独居、独立程度、不良生活事件、家庭收入、社会支持和个性特征等^[15-17]。	1	A
	2.建议医护人员应早期评估高危患者，早期预防、及时治疗。	1	A
筛查	1.推荐由专业人员对高危人群，均常规使用经过验证的筛查工具进行评估^[18]。	1	A
	2.推荐常规使用HAMD、HAMA、SDS、SAS筛查量表，对患者进行筛查^[18]。	1	A
	3.抑郁量表筛查结合临床评估综合确证^{[7, 18]}。	2	B
预防	1.坚持早发现早干预的原则，推荐采用行为认知疗法、社会支持和社会参与、心理干预等进行预防^{[7-11, 16]}。	1	A
	2.推荐护士评估患者的健康状况，有助于护士了解患者需求^[25]。	2	B
	3.建议医护人员接受抑郁干预的相关培训，预防性心理开导高风险患者^[8]。	2	A
治疗	1.推荐药物治疗、非药物治疗相结合，疗效会高于单一疗法^[10]。	1	A
	2.推荐药物治疗首选SSRI类抗抑郁药，且必须进行不良反应监测^[11]。	1	A
	3.推荐抑郁早期采用非药物治疗，包括心理咨询、音乐疗法、干预和教育生活方式、认知行为疗法或人际关系疗法^[13-14]。	5	A
	4.推荐患者家人、朋友给予更多的关心、陪伴以及情感支持，鼓励患者积极接受治疗和康复锻炼。	5	B
宣教	1.推荐护理人员向患者及家属提供有关抑郁情绪的潜在影响因素和健康教育，提高他们对抑郁的认识及重视。	1	B
	2.建议护士提高倾听、沟通技巧技能，引导患者通过精神信仰、实践以减轻抑郁。	2	A
	3.健康教育时要提供材料，教育后要跟踪和随访，以确保患者正确理解并酌情重复内容。	1	A

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