Koertge J, Janszky I, Sundin O, Blom M, Georgiades A, László K D, Alinaghizadeh H, Ahnve S
Preventive Medicine, Department of Public Health Sciences, Karolinska Institutet, and Centre of Public Health, Stockholm County Council, Stockholm, Sweden.
J Intern Med. 2008 Mar;263(3):281-93. doi: 10.1111/j.1365-2796.2007.01887.x. Epub 2007 Dec 7.
Psychosocial factors, including depression and vital exhaustion (VE) are associated with adverse outcome in coronary heart disease (CHD). Women with CHD are poor responders to psychosocial treatment and knowledge regarding which treatment modality works in them is limited. This randomized controlled clinical study evaluated the effect of a 1-year stress management program, aimed at reducing symptoms of depression and VE in CHD women.
Patients were 247 women, < or =75 years, recruited consecutively after a cardiac event and randomly assigned to either stress management (20 2-h sessions) and medical care by a cardiologist, or to obtaining usual health care as controls. Measurements at; baseline (6-8 weeks after randomization), 10 weeks (after 10 intervention sessions), 1 year (end of intervention) and 1-2 years follow-up.
For VE, intention to treat analysis showed effects for time (P < 0.001) and time x treatment interaction (P = 0.005), reflecting that both groups improved over time, and that the decrease of VE was more pronounced in the intervention group. However, the level of VE was higher in the intervention group than amongst controls at baseline, 22.7 vs. 19.4 (P = 0.036) but it did not differ later. The change in depressive symptoms did not differ between the groups.
CHD women attending our program experienced a more pronounced decrease in VE than controls. However, as they had higher baseline levels, due to regression towards the mean we cannot attribute the decrease in VE to the intervention. Whether the program has long-term beneficial effects needs to be evaluated.
心理社会因素,包括抑郁和倦怠(VE)与冠心病(CHD)的不良预后相关。冠心病女性对心理社会治疗反应不佳,且关于哪种治疗方式对她们有效的知识有限。这项随机对照临床研究评估了一项为期1年的压力管理计划对减少冠心病女性抑郁和倦怠症状的效果。
患者为247名年龄≤75岁的女性,在发生心脏事件后连续招募,并随机分配到压力管理组(20次2小时课程)并由心脏病专家提供医疗护理,或接受常规医疗护理作为对照组。在基线(随机分组后6 - 8周)、10周(10次干预课程后)、1年(干预结束时)和1 - 2年随访时进行测量。
对于倦怠,意向性分析显示时间效应(P < 0.001)和时间×治疗交互作用(P = 0.005),表明两组均随时间改善,且干预组倦怠的降低更为明显。然而,干预组在基线时的倦怠水平高于对照组,分别为22.7和19.4(P = 0.036),但之后并无差异。两组之间抑郁症状的变化没有差异。
参加我们计划的冠心病女性的倦怠下降比对照组更明显。然而,由于她们的基线水平较高,因均值回归,我们不能将倦怠的降低归因于干预。该计划是否具有长期有益效果需要评估。