为期一年的多模式门诊减重项目提前终止的心理和社会人口学预测因素：一项失访分析
Psychological and sociodemographic predictors of premature discontinuation of a 1-year multimodal outpatient weight-reduction program: an attrition analysis.
作者信息
Ahnis Anne, Riedl Andrea, Figura Andrea, Steinhagen-Thiessen Elisabeth, Liebl Max E, Klapp Burghard F
机构信息
Internal Medicine and Dermatology, Medical Department, Division of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, Campus Mitte.
出版信息
Patient Prefer Adherence. 2012;6:165-77. doi: 10.2147/PPA.S28022. Epub 2012 Mar 7.
OBJECTIVE
Attrition rates of up to 77% have been reported in conservative weight-reduction programs for the treatment of obesity. In view of the cost of such programs to the health system, there is a need to identify the variables that predict premature discontinuation of treatment. Previous studies have focused mainly on somatic and sociodemographic parameters. The prospective influence of psychological factors has not been systematically investigated to date.
METHODS
A total of 164 patients (138 of whom were women) with a mean age of 45 years and a mean body mass index of 39.57 participated in a 1-year outpatient weight-reduction program at the Charité - Universitätsmedizin Berlin University Hospital. The program included movement therapy, dietary advice, psychoeducational and behavioral interventions, relaxation procedures, and consultations with a specialist in internal medicine and a psychologist. Patients also underwent regular laboratory and psychological testing. The results were evaluated using a t-test, χ(2)-test, and logistic regression analysis.
RESULTS
Seventy-one of the 164 patients (61 women, mean age = 43 years, mean body mass index = 39.53) withdrew before the end of the program (attrition rate = 43.3%). While there were no differences between the somatic and metabolic characteristics of those who withdrew and those who remained, the sociodemographic and psychological factors had some relevance. In particular, "expectation of self-efficacy" (Fragebogen zu Selbstwirksamkeit, Optimismus und Pessimismus [SWOP]), "not working," "tiredness" (Berliner Stimmungsfragebogen [BSF]), "pessimism" (SWOP) and "positive reframing" (Brief-COPE) were found to play a role in whether participants subsequently dropped out of the treatment. "Support coping" (Brief-COPE) and "older age" prior to the start of treatment were identified as variables that promoted treatment adherence.
CONCLUSION
The results are discussed in light of previous findings and with regard to whether the modules of the weight-reduction program should be adapted.
目的
据报道，在治疗肥胖症的保守减重项目中，脱落率高达77%。鉴于此类项目给卫生系统带来的成本，有必要确定能够预测治疗提前中断的变量。以往研究主要集中在躯体和社会人口学参数上。心理因素的前瞻性影响迄今为止尚未得到系统研究。
方法
共有164名患者（其中138名女性）参与了柏林夏里特大学医院为期1年的门诊减重项目，这些患者的平均年龄为45岁，平均体重指数为39.57。该项目包括运动疗法、饮食建议、心理教育和行为干预、放松程序，以及与内科专家和心理学家的咨询。患者还接受了定期的实验室和心理测试。结果采用t检验、χ²检验和逻辑回归分析进行评估。
结果
164名患者中有71名（61名女性，平均年龄 = 43岁，平均体重指数 = 39.53）在项目结束前退出（脱落率 = 43.3%）。虽然退出者和未退出者的躯体和代谢特征没有差异，但社会人口学和心理因素有一定相关性。特别是，“自我效能期望”（自我效能、乐观主义和悲观主义问卷[SWOP]）、“无工作”、“疲倦”（柏林情绪问卷[BSF]）、“悲观主义”（SWOP）和“积极重新评价”（简易应对方式问卷）被发现与参与者随后是否退出治疗有关。“支持应对”（简易应对方式问卷）和治疗开始前“年龄较大”被确定为促进治疗依从性的变量。
结论
根据先前的研究结果以及减重项目的模块是否应进行调整对结果进行了讨论。
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