面向夫妻的慢性病干预措施的回顾和荟萃分析。
Review and meta-analysis of couple-oriented interventions for chronic illness.
机构信息
Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA 16802, USA.
出版信息
Ann Behav Med. 2010 Dec;40(3):325-42. doi: 10.1007/s12160-010-9216-2.
BACKGROUND
Evidence continues to build for the impact of the marital relationship on health as well as the negative impact of illness on the partner. Targeting both patient and partner may enhance the efficacy of psychosocial or behavioral interventions for chronic illness.
PURPOSE
The purpose of this report is to present a cross-disease review of the characteristics and findings of studies evaluating couple-oriented interventions for chronic physical illness.
METHODS
We conducted a qualitative review of 33 studies and meta-analyses for a subset of 25 studies.
RESULTS
Identified studies focused on cancer, arthritis, cardiovascular disease, chronic pain, HIV, and Type 2 diabetes. Couple interventions had significant effects on patient depressive symptoms (d = 0.18, p < 0.01, k = 20), marital functioning (d = 0.17, p < 0.01, k = 18), and pain (d = 0.19, p < 0.01, k = 14) and were more efficacious than either patient psychosocial intervention or usual care.
CONCLUSIONS
Couple-oriented interventions have small effects that may be strengthened by targeting partners' influence on patient health behaviors and focusing on couples with high illness-related conflict, low partner support, or low overall marital quality. Directions for future research include assessment of outcomes for both patient and partner, comparison of couple interventions to evidence-based patient interventions, and evaluation of mechanisms of change.
背景
越来越多的证据表明婚姻关系对健康有影响，疾病对伴侣也有负面影响。针对患者和伴侣双方可能会提高慢性疾病心理社会或行为干预的效果。
目的
本报告旨在对评估针对慢性躯体疾病的夫妻为导向干预措施的研究进行跨疾病综述，介绍其特点和研究结果。
方法
我们对 33 项研究和荟萃分析中的 25 项研究进行了定性综述。
结果
确定的研究重点是癌症、关节炎、心血管疾病、慢性疼痛、艾滋病毒和 2 型糖尿病。夫妻干预对患者抑郁症状（d=0.18，p<0.01，k=20）、婚姻功能（d=0.17，p<0.01，k=18）和疼痛（d=0.19，p<0.01，k=14）有显著影响，比患者心理社会干预或常规护理更有效。
结论
夫妻为导向的干预措施有较小的效果，通过针对伴侣对患者健康行为的影响，以及关注与疾病相关冲突、伴侣支持低或整体婚姻质量低的夫妻，可以加强这些效果。未来研究的方向包括评估患者和伴侣的结果，比较夫妻干预与基于证据的患者干预，以及评估变化的机制。
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