台湾台北市针对女性抑郁症门诊患者的两种心理健康护士随访计划模式的效果比较。

Hsiao Fei-Hsiu, Yang Tsung-Tsair, Chen Chiao-Chicy, Tsai Shang-Ying, Wang Kuo-chang, Lai Yu-Ming, Tsai Chang-Jer, Chang Wen-Yin

College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan.

J Clin Nurs. 2007 Jun;16(6):1141-50. doi: 10.1111/j.1365-2702.2007.01718.x.

AIMS AND OBJECTIVES

This study compares the effectiveness of two modalities of mental health nurse three-month follow-up programmes: telephone counselling programme and group therapy programme for female outpatients with depression.

BACKGROUND

The lifetime prevalence of major depression is 15% and is about twice as common in women as in men. Outpatients with depression often discontinue their treatment after the initial visits to their physicians.

METHODS

This study used a quasi-experimental, pre-post-test comparison group design. Twenty-six female outpatients with depression were assigned to one of follow-up programmes: telephone counselling programme or group therapy programme. To qualify for group therapy programme, potential participants were required to come to group sessions weekly. To be accepted into telephone counselling programme, potential participants had to be able to be contacted by phone regularly. Mental health nurse three-month follow-up programmes included care management and structured psychotherapy. Patients in telephone counselling programme received 10 regular telephone calls of 30-60 minutes each. Patients in group therapy programme received 12 sessions of weekly group meetings of 90-120 minutes each.

RESULTS

Wilcoxon signed ranks tests provided evidence that the group therapy programme (S = -52.5, p < 0.001; S = 31.5, p = 0.046) and telephone counselling programme (S = -36, p = 0.002; S = 25, p = 0.050) follow-up programmes were effective in terms of relieving depressed symptoms and improving quality of life. According to Quade's analysis of covariance, telephone counselling programme and group therapy programme appeared to have similar effects of relieving depressed symptoms (F(1,24) = 0.06, p = 0.813) and increasing quality of life (F(1,24) = 0.07, p = 0.792). While there was no significant difference in using emergency services ( chi(2)(1)= 0.89, p = 0.539) between telephone counselling programme and group therapy programme, the rate of adherence to scheduled outpatient appointments with psychiatrists was higher among patients in group therapy programme than patients in telephone counselling programme (chi(2)(3) = 8.67, p = 0.034).

CONCLUSIONS

Establishing two modalities of mental health nurse follow-up programmes in Taiwan could benefit patients with different needs.

RELEVANCE TO CLINICAL PRACTICE

Mental health nurses specialized in management of depression could provide not only care management but also structured psychotherapy.

目的与目标

本研究比较了心理健康护士开展的两种为期三个月的随访项目模式的有效性：针对患有抑郁症的女性门诊患者的电话咨询项目和团体治疗项目。

背景

重度抑郁症的终生患病率为15%，女性患病率约为男性的两倍。抑郁症门诊患者在初次就诊后往往会中断治疗。

方法

本研究采用了准实验性的前后测比较组设计。26名患有抑郁症的女性门诊患者被分配到其中一个随访项目中：电话咨询项目或团体治疗项目。要符合团体治疗项目的条件，潜在参与者需要每周参加团体会议。要被纳入电话咨询项目，潜在参与者必须能够定期通过电话联系到。心理健康护士开展的为期三个月的随访项目包括护理管理和结构化心理治疗。电话咨询项目的患者接受10次定期电话咨询，每次30 - 60分钟。团体治疗项目的患者接受12次每周一次的团体会议，每次90 - 120分钟。

结果

威尔科克森符号秩检验提供的证据表明，团体治疗项目（S = -52.5，p < 0.001；S = 31.5，p = 0.046）和电话咨询项目（S = -36，p = 0.002；S = 25，p = 0.050）的随访项目在缓解抑郁症状和改善生活质量方面是有效的。根据奎德协方差分析，电话咨询项目和团体治疗项目在缓解抑郁症状（F(1,24) = 0.06，p = 0.813）和提高生活质量（F(1,24) = 0.07，p = 0.792）方面似乎有相似的效果。虽然电话咨询项目和团体治疗项目在使用紧急服务方面没有显著差异（卡方(2)(1)= 0.89，p = 0.539），但团体治疗项目患者遵守与精神科医生预约门诊的比例高于电话咨询项目患者（卡方(3)(3) = 8.67，p = 0.034）。