University Health Network, Program in Medical Psychiatry, Canada.
J Hepatol. 2012 Dec;57(6):1299-304. doi: 10.1016/j.jhep.2012.07.032. Epub 2012 Aug 4.
BACKGROUND & AIMS: Recognizing the importance of adherence to therapy in autoimmune hepatitis (AIH) is critical for patient care and avoidance of unnecessary intervention. The influence of psychosocial factors on treatment adherence needs better understanding and prominence. We sought to determine the association between anxiety, depressive symptoms, and avoidant relationship style on self-reported immunosuppressant medication adherence and treatment response in patients with AIH.
Fifty two patients with AIH were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Experiences in Close Relationship Scale (ECR) and a visual analogue scale to measure self-reported adherence. Laboratory markers of adherence and immunosuppressant treatment response were recorded. Chi-square Fisher's exact or Wilcox rank sum tests were used for comparison between groups.
Treatment responders compared to non-responders were older (p=0.035), had normal or mild score ranges for anxiety and depression (p=0.025) and were significantly more likely to report >80% treatment adherence (p=0.007). Non-responders had higher anxiety symptoms (p=0.025), and significantly higher ECR-avoidance scores (p=0.023), suggestive of a tendency towards a more avoidant relationship style.
We formally document that patients with AIH who have higher depressive and anxiety symptoms and avoidant relationship styles are more likely to be non-adherent to AIH therapy. We reiterate the need for early recognition and treatment of anxiety and depression in patients with AIH, stress the need for treatment adherence and highlight the need for formal evaluation of these factors in trials of therapy targeting apparent treatment non-responders.
认识到自身免疫性肝炎（AIH）患者治疗依从性的重要性，对于患者的护理和避免不必要的干预至关重要。心理社会因素对治疗依从性的影响需要更好地理解和重视。我们旨在确定焦虑、抑郁症状和回避型关系风格与 AIH 患者自我报告的免疫抑制剂药物依从性和治疗反应之间的关系。
使用患者健康问卷-9、广泛性焦虑障碍-7、亲密关系经历量表（ECR）和视觉模拟量表评估 52 例 AIH 患者，以评估自我报告的依从性。记录实验室标记物的依从性和免疫抑制剂治疗反应。使用卡方 Fisher 精确检验或 Wilcox 秩和检验比较组间差异。
与无应答者相比，应答者年龄较大（p=0.035），焦虑和抑郁评分范围正常或轻度（p=0.025），且更有可能报告>80%的治疗依从性（p=0.007）。无应答者焦虑症状较高（p=0.025），且 ECR-回避评分显著较高（p=0.023），提示其关系风格更倾向于回避。
我们正式证明，AIH 患者的抑郁和焦虑症状较高且关系风格回避型，更有可能不依从 AIH 治疗。我们再次强调需要早期识别和治疗 AIH 患者的焦虑和抑郁，强调治疗依从性的重要性，并强调需要在针对明显治疗无应答者的治疗试验中正式评估这些因素。
