Fogel Joshua, Fauerbach James A, Ziegelstein Roy C, Bush David E
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
J Psychosom Res. 2004 Jan;56(1):75-82. doi: 10.1016/S0022-3999(03)00563-4.
To prospectively study the relationship of quality of life (QOL) to adherence among myocardial infarction (MI) patients and also to determine if either QOL or depressive symptoms (DEP) has a primary role in predicting adherence.
Acute-MI patients (N=285) were administered questionnaires on QOL, DEP, and adherence in-hospital and 4 months post-MI. The seven adherence behaviors measured included (1). following a low-salt diet, (2). following a low-fat or weight loss diet, (3). taking prescribed medication, (4). exercising regularly, (5). decreasing stress, (6). carrying medical supplies for self-care, and (7). trying to socialize more with others. Hierarchical regression analyses examined cross-sectional and prospective relations between adherence and both physical and mental health QOL domains. Each QOL domain was modeled as "adherence=QOL domain+DEP."
Physical health QOL was related to adherence using cross-sectional and prospective approaches even with DEP independently still related to adherence. Conversely, in separate models using cross-sectional and prospective approaches, mental health QOL was not related to adherence while DEP was related to adherence.
Focused attention on those with low scores in physical health QOL or greater DEP may be an efficient approach to improve adherence in patients recovering from an MI.
前瞻性研究心肌梗死(MI)患者的生活质量(QOL)与依从性之间的关系,并确定QOL或抑郁症状(DEP)在预测依从性方面是否起主要作用。
对急性心肌梗死患者(N = 285)在住院期间及心肌梗死后4个月进行生活质量、抑郁症状和依从性问卷调查。所测量的七种依从行为包括:(1)遵循低盐饮食;(2)遵循低脂或减肥饮食;(3)服用处方药;(4)定期锻炼;(5)减轻压力;(6)携带医疗用品进行自我护理;(7)尝试更多地与他人交往。分层回归分析检验了依从性与身心健康生活质量领域之间的横断面和前瞻性关系。每个生活质量领域的模型为“依从性=生活质量领域+抑郁症状”。
即使抑郁症状仍独立与依从性相关,但采用横断面和前瞻性方法时,身体健康生活质量与依从性相关。相反,在使用横断面和前瞻性方法的单独模型中,心理健康生活质量与依从性无关,而抑郁症状与依从性相关。
对身体健康生活质量得分低或抑郁症状较重的患者给予重点关注,可能是提高心肌梗死康复患者依从性的有效方法。