自助式正念干预对抑郁症患者病耻感及心理弹性的影响

毕洪生; 代佳利; 孙大伟

doi:10.16766/j.cnki.issn.1674-4152.003299

自助式正念干预对抑郁症患者病耻感及心理弹性的影响

doi: 10.16766/j.cnki.issn.1674-4152.003299

1.
大庆市第三医院精神科九病区，黑龙江大庆 163000
2.
大庆市第三医院老年心理科

基金项目:

黑龙江省卫生健康委科研项目 20220303090993

大庆市指导性科技项目 zdy-2021-21

详细信息

通讯作者:
孙大伟，E-mail：dqsyysdw@163.com

中图分类号: R749.05
计量
- 文章访问数: 79
- HTML全文浏览量: 43
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-12
- 网络出版日期: 2024-01-29

Effect of self-help mindfulness-based intervention on stigma and resilience in patients with depression

1.
Psychiatric No.9 Ward, the Third Hospital of Daqing, Daqing, Heilongjiang 163000, China

摘要

摘要: 目的抑郁症患者具有较高的病耻感及较低的心理弹性。正念干预是减轻抑郁症患者病耻感，提升其心理弹性的有效方式之一，本研究采用自助式正念课程进行干预，探讨其对抑郁症患者正念水平、病耻感及心理弹性的影响。方法选取2022年1—11月就诊于大庆市第三医院门诊的抑郁症患者为研究对象。以随机数字表法将招募的142例抑郁症患者分为对照组(71例)和实验组(71例)，对照组给予常规药物治疗，实验组在常规药物治疗的基础上给予自助式正念干预。由于各种原因，实验组脱落15例，对照组脱落11例，最后完成实验的总人数为116例，实验组56例，对照组60例。于干预前及干预8周后用五因素正念度量表(FFMQ)、抑郁症病耻感量表(DSS)、心理韧性量表(CD-RISC)进行评估。结果干预后，实验组FFMQ量表总得分[(112.80±15.86)分]高于对照组[(98.97±15.42)分]，CD-RISC量表总得分[(54.52±10.46)分]高于对照组[(47.23±9.71)分]，而DSS量表总得分[(43.84±10.95)分]低于对照组[(48.28±11.00)分]，差异均有统计学意义(t=4.764、3.889、2.179，均P＜0.05)。实验组干预后FFMQ量表总得分、CD-RISC量表总得分均高于干预前，而DSS量表总得分低于干预前，差异均有统计学意义(均P＜0.05)。结论自助式正念干预能有效提升抑郁症患者正念水平及心理弹性，减轻其病耻感。
- 正念 /
- 抑郁症 /
- 病耻感 /
- 心理弹性 /
- 自助式
Abstract: Objective Patients with depression have higher stigma and lower psychological resilience. Mindfulness intervention is one of the effective ways to reduce the stigma of patients with depression and improve their psychological resilience. This study used a self-help mindfulness course to intervene and explore its effects on the level of mindfulness, stigma, and psychological resilience of patients with depression. Methods Patients with depression who visited the outpatient department of the Third Hospital of Daqing from January 2022 to November 2022 were selected as the research subjects. One hundred and forty-two recruited depression patients were randomly divided into a control group (n=71) and an experimental group (n=71). The control group received routine drug treatment, while the experimental group received self-help mindfulness-based intervention based on routine drug treatment. Due to various reasons, 15 cases dropped out of the experimental group and 11 cases dropped out of the control group. Finally, the total number of patients who completed the experiment was 116, 56 cases in the experimental group and 60 cases in the control group. Five facet mindfulness questionnaire (FFMQ), depression stigma scale (DSS), and connor-davidson resilience scale (CD-RISC) were used before and after the intervention for 8 weeks. Results After intervention, the total score of the FFMQ in the experimental group [(112.80±15.86) points] was higher than that in the control group [(98.97±15.42) points], the total score of the CD-RISC [(54.52±10.46) points] was higher than that in the control group [(47.23±9.71) points], and the total score of the DSS [(43.84±10.95) points] was lower than that in the control group [(48.28±11.00) points], the differences were statistically significant (t=4.764, 3.889, 2.179; all P < 0.05). After the intervention, the total scores of FFMQ and CD-RISC in the experimental group were higher than before the intervention, while the total scores of DSS were lower than before the intervention, the differences were statistically significant (all P < 0.05). Conclusion Self-help mindfulness-based intervention can effectively improve the mindfulness level and resilience of patients with depression, and reduce their stigma.
- Mindfulness /
- Depression /
- Stigma /
- Resilience /
- Self-help

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表 1 8周正念课程表

Table 1. 8-week schedule for a mindfulness-based course

时间	内容
第1周	了解正念；抑郁症科普知识；身体扫描；正念呼吸；生活中的正念
第2周	身体扫描；正念瑜伽；摆脱反刍思维；停止思维的自动导航
第3周	身体扫描；正念冥想；正念呼吸；想法不等于事实；活在当下
第4周	身体扫描；正念瑜伽；正念冥想；觉察自己的情绪；提升专注力
第5周	身体扫描；正念瑜伽；正念冥想；接受负面情绪
第6周	身体扫描；正念冥想；正念呼吸；如何更好地关心自己
第7周	身体扫描；正念冥想；正念瑜伽；如何将正念融入生活
第8周	身体扫描；正念冥想；正念呼吸；如何保持正念

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表 2 2组抑郁症患者干预前后FFMQ评分比较(x±s，分)

Table 2. Comparison of FFMQ scores between two groups of depression patients before and after intervention (x±s, points)

组别	例数	FFMQ总分		观察维度		描述维度
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
实验组	56	100.32±17.50	112.80±15.86^a	21.86±5.35	24.27±4.82^a	22.71±4.55	24.82±4.25^a
对照组	60	99.28±16.30	98.97±15.42	21.42±5.02	21.27±4.90	22.47±4.34	22.40±4.28
t值		0.331	4.764	0.457	3.323	0.300	3.056
P值		0.741	＜0.001	0.648	0.001	0.765	0.003

组别	例数	觉知地行动维度		不判断维度		不反应维度
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
实验组	56	20.02±5.20	22.52±4.83^a	18.80±4.94	21.34±5.54^a	16.93±4.36	19.86±4.61^a
对照组	60	19.90±5.32	19.60±5.03	18.47±4.58	18.30±4.51	17.03±3.93	17.40±3.58
t值		0.121	3.183	0.381	3.224	0.136	3.218
P值		0.904	0.002	0.704	0.002	0.892	0.002
注：与同组干预前比较，^aP＜0.05。

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表 3 2组抑郁症患者干预前后DSS得分比较(x±s，分)

Table 3. Comparison of DSS scores before and after intervention between two groups of depression patients (x±s, points)

组别	例数	DSS总分		个人病耻感维度		感知病耻感维度
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
实验组	56	49.14±11.41	43.84±10.95^a	23.79±6.61	21.04±6.53^a	25.36±5.14	22.80±4.90^a
对照组	60	48.27±11.05	48.28±11.00	23.33±6.40	23.42±6.34	24.93±4.67	24.87±5.02
t值		0.420	2.179	0.452	1.993	0.374	2.239
P值		0.675	0.031	0.652	0.049	0.709	0.027
注：与同组干预前比较，^aP＜0.05。

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表 4 2组抑郁症患者干预前后CD-RISC评分比较(x±s，分)

Table 4. Comparison of CD-RISC scores before and after intervention between two groups of depression patients (x±s, points)

组别	例数	CD-RISC总分		坚韧性维度		力量性维度		乐观性维度
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
实验组	56	48.04±10.23	54.52±10.46^a	25.43±6.64	28.02±6.96^a	15.08±4.27	17.64±4.36^a	6.80±1.78	8.86±1.83^a
对照组	60	47.47±10.21	47.23±9.71	24.98±6.79	24.55±6.15	15.72±4.13	15.77±4.18	6.77±1.72	6.92±1.87
t值		0.300	3.889	0.357	2.848	0.111	2.364	0.113	0.910
P值		0.765	＜0.001	0.722	0.005	0.912	0.020	5.636	＜0.001
注：与同组干预前比较，^aP＜0.05。

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参考文献(25)

[1]	BEUREL E, TOUPS M, NEMEROFF C B. The bidirectional relationship of depression and inflammation: double trouble[J]. Neuron, 2020, 107(2): 234-256. doi: 10.1016/j.neuron.2020.06.002
[2]	MALHI G S, MANN J J. Depression[J]. Lancet, 2018, 392(10161): 2299-2312. doi: 10.1016/S0140-6736(18)31948-2
[3]	TOWNSEND M, PAREJA K, BUCHANAN-HUGHES A, et al. Antipsychotic-related stigma and the impact on treatment choices: a systematic review and framework synthesis[J]. Patient Prefer Adherence, 2022, 16: 373-401. doi: 10.2147/PPA.S343211
[4]	李德重, 岳阳, 孙连峰, 等. 抑郁症患者病耻感现状及影响因素分析[J]. 国际精神病学杂志, 2021, 48(6): 1001-1003. LI D Z, YUE Y, SUN L F, et al. The status and influencing factors of stigma of depression patients[J]. Journal of International Psychiatry, 2021, 48(6): 1001-1003.
[5]	王腾, 汝荣荣, 孙丽娜. 心理弹性对糖尿病患者家庭关怀度与自我管理行为的中介效应分析[J]. 河北医药, 2022, 44(23): 3623-3625, 3629. WANG T, RU R R, SUN L N. Analysis on mediating effects of resilience on family care and self-management behaviors in patients with diabetes mellitus[J]. Hebei Medical Journal, 2022, 44(23): 3623-3625, 3629.
[6]	李文俊, 布龙华, 郑竻云, 等. 抑郁症患者心理弹性与自尊水平及自我病耻感相关性分析[J]. 临床心身疾病杂志, 2022, 28(3): 95-97. LI W J, BU L H, ZHENG L Y, et al. Correlation analysis of psychological resilience, self-esteem and self-stigma in patients with depression[J]. Journal of Clinical Psychosomatic Diseases, 2022, 28(3): 95-97.
[7]	WANG G P, LIU X Y, LEI J. Effects of mindfulness-based intervention for women with infertility: a systematic review and meta-analysis[J]. Arch Womens Ment Health, 2023, 26(2): 245-258. doi: 10.1007/s00737-023-01307-2
[8]	赵勋, 齐梦影, 严谨, 等. 稳定期COPD患者正念干预的研究进展[J]. 中国护理管理, 2020, 20(12): 1902-1906. ZHAO X, QI M Y, YAN J, et al. Research progress of Mindfulness Based Intervention in patients with stable chronic obstructive pulmonary disease[J]. Chinese Nursing Management, 2020, 20(12): 1902-1906.
[9]	袁雪娇, 武静, 宗薇, 等. 团体正念减压训练对抑郁症患者病耻感及睡眠质量的影响[J]. 护理学杂志, 2019, 34(21): 60-63. YUAN X J, WU J, ZONG W, et al. Effect of group mindfulness-based stress reduction therapy on stigma and sleep quality in depressed patients[J]. Journal of Nursing Science, 2019, 34(21): 60-63.
[10]	李海红. 正念减压对抑郁症患者心理弹性及睡眠质量的影响[J]. 中国农村卫生, 2021, 13(9): 40-42. LI H H. The effect of mindfulness-based reduce stress on resilience and sleep quality in patients with depression[J]. China Rural Health, 2021, 13(9): 40-42.
[11]	李建华, 许玉芳, 王晓娥, 等. 正念干预对抑郁症患者病耻感和应对方式的影响[J]. 中国健康心理学杂志, 2019, 27(4): 484-489. LI J H, XU Y F, WANG X E, et al. Effects of mindfulness-based intervention on stigma and coping style in patients with depression[J]. China Journal of Health Psychology, 2019, 27(4): 484-489.
[12]	王杰, 杨红梅, 王传霞, 等. 自助式正念训练对胃癌患者焦虑情绪及应对方式的影响[J]. 齐鲁护理杂志, 2020, 26(22): 11-14. WANG J, YANG H M, WANG C X, et al. Influence of self-help mindfulness training on anxiety and coping style of gastric cancer patients[J]. Journal of Qilu Nursing, 2020, 26(22): 11-14.
[13]	SHAO D, ZHANG H H, CUI N X, et al. The efficacy and mechanisms of a guided self-help intervention based on mindfulness in patients with breast cancer: a randomized controlled trial[J]. Cancer, 2021, 127(9): 1377-1386. doi: 10.1002/cncr.33381
[14]	CARPENTER J K, CONROY K, GOMEZ A F, et al. The relationship between trait mindfulness and affective symptoms: a meta-analysis of the Five Facet Mindfulness Questionnaire(FFMQ)[J]. Clin Psychol Rev, 2019, 74: 101785. DOI: 10.1016/j.cpr.2019.101785.
[15]	冯国艳, 张春青, 史可可, 等. 情绪劳动对高校教师工作满意度的影响: 正念的中介效应与组织认同的调节效应[J]. 中国健康心理学杂志, 2022, 30(11): 1673-1680. FENG G Y, ZHANG C Q, SHI K K, et al. Effect of emotional labor on university teachers ' job satisfaction: the mediating role of mindfulness and the moderating role of organizational identity[J]. China Journal of Health Psychology, 2022, 30(11): 1673-1680.
[16]	刘烁, 杨芳, 王晓琴, 等. 抑郁症病耻感量表的汉化及在社区人群中的信效度评价[J]. 中国健康教育, 2022, 38(7): 609-612, 630. LIU S, YANG F, WANG X Q, et al. Reliability and validity of the Chinese version of depression stigma scale in community residents[J]. Chinese Journal of Health Education, 2022, 38(7): 609-612, 630.
[17]	BIZRI M, LBRHIM N, BEYROUTHY C, et al. Psychometric properties of the Arabic version of Connor-Davidson Resilience Scale in a sample of Lebanese women[J]. PLoS One, 2022, 17(6): e0269700. DOI: 10.1371/journal.pone.0269700.
[18]	MILLER M J, MEALER M L, COOK P F, et al. Psychometric assessment of the connor-davidson resilience scale for people with lower-limb amputation[J]. Phys Ther, 2021, 101(4): pzab002. DOI: 10.1093/ptj/pzab002.
[19]	高贵元, 黄捷, 刘丹, 等. 抑郁症的发病机制及抗抑郁药物的研究进展[J]. 中国医药导报, 2021, 18(1): 52-55, 70. GAO G Y, HUANG J, LIU D, et al. The pathogenesis of depression and the research progress of antidepressants[J]. China Medical Herald, 2021, 18(1): 52-55, 70.
[20]	ZHANG D X, LEE E K P, MAK E C W, et al. Mindfulness-based interventions: an overall review[J]. Br Med Bull, 2021, 138(1): 41-57. doi: 10.1093/bmb/ldab005
[21]	CRESWELL J D, LINDSAY E K, VILLALBA D K, et al. Mindfulness training and physical health: mechanisms and outcomes[J]. Psychosom Med, 2019, 81(3): 224-232. doi: 10.1097/PSY.0000000000000675
[22]	曾俊, 夏添. 正念认知治疗对急性脑梗死患者病耻感、自我效能及生活质量的影响[J]. 中国健康心理学杂志, 2020, 28(1): 33-37. ZENG J, XIA T. Effect of mindfulness-based cognitive therapy on stigma, self-efficacy and quality of life in patients with acute cerebral infarction[J]. China Journal of Health Psychology, 2020, 28(1): 33-37.
[23]	李红燕, 张红艳, 任占芬, 等. 基于互联网的正念减压疗法心理护理在炎性关节炎患者中的应用效果[J]. 中华全科医学, 2019, 17(4): 625-629. doi: 10.16766/j.cnki.issn.1674-4152.000752 LI H Y, ZHANG H Y, REN Z F, et al. Application of internet based mindfulness stress reduction psychological nursing therapy in the nursing of patients with inflammatory arthritis[J]. Chinese Journal of General Practice, 2019, 17(4): 625-629. doi: 10.16766/j.cnki.issn.1674-4152.000752
[24]	SEDIC B, STRKALJ IVEZIC S, PERAKE O, et al. Differences in resilience, self-stigma and mental health recovery between patients with schizophrenia and depression[J]. Psychiatr Danub, 2021, 33(Suppl 4): 518-528.
[25]	毛英莹, 刘东玮, 孟丽娜, 等. 精神分裂症患者病耻感对孤独感的影响: 心理弹性与希望的链式中介作用[J]. 中国卫生事业管理, 2020, 37(11): 844-847. MAO Y Y, LIU D W, MENG L N, et al. Studying on the influence of stigma on loneliness of patients with schizophrenia based on the chain mediating role of resilience and hope[J]. Chinese Health Service Management, 2020, 37(11): 844-847.