Department of Psychiatry and Behavioral Sciences.
Department of Biostatistics, University of North Carolina at Chapel Hill.
Health Psychol. 2019 Jun;38(6):502-508. doi: 10.1037/hea0000716. Epub 2019 Apr 18.
We examined the modifying effects of social support on depressive symptoms and health-related quality of life (QoL) in patients receiving coping skills training (CST).
We considered the modifying effects of social support in the Coping Effectively with Heart Failure clinical trial, which randomized 179 heart failure (HF) patients to either 4 months of CST or usual care enhanced by HF education (HFE). CST involved training in specific coping techniques, whereas HFE involved education about HF self-management. Social support was assessed by the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory, QoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and depression was assessed with the Beck Depression Inventory-II (BDI-II).
Linear regression models revealed a significant Intervention Group × Baseline Social Support interaction for change in KCCQ total scores (p = .006) and BDI-II scores (p < .001). Participants with low social support assigned to the CST intervention showed large improvements in KCCQ scores (M = 11.2, 95% CI [5.7, 16.8]), whereas low-social-support patients assigned to the HFE controls showed no significant change (M = -0.8, 95% CI [-7.2, 5.6]). Similarly, BDI-II scores in participants with low social support in the CST group showed large reductions (M = -8.7, 95% CI [-11.3, -6.1]) compared with low-social-support HFE participants (M = -3.0, 95% CI [-6.0, -0.1]).
HF patients with low social support benefit substantially from telephone-based CST interventions. Targeting HF patients with low social support for behavioral interventions could prove to be a cost-effective strategy for improving QoL and reducing depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
本研究旨在探讨社会支持对接受应对技能训练（CST）患者抑郁症状和健康相关生活质量（QoL）的调节作用。
我们在“心力衰竭患者应对技能训练有效性研究”中探讨了社会支持的调节作用，该研究将 179 例心力衰竭（HF）患者随机分为 CST 组（4 个月）或 HF 教育强化的常规护理组（HFE）。CST 包括特定应对技术的培训，而 HFE 则包括 HF 自我管理教育。社会支持通过增强冠心病患者康复（ENRICHD）社会支持量表进行评估，QoL 通过堪萨斯城心肌病问卷（KCCQ）进行评估，抑郁通过贝克抑郁自评量表 II（BDI-II）进行评估。
线性回归模型显示，KCCQ 总分（p =.006）和 BDI-II 评分（p <.001）的变化存在显著的干预组×基线社会支持的交互作用。社会支持水平较低的患者被分配到 CST 干预组后，KCCQ 评分有显著提高（M = 11.2，95%CI [5.7, 16.8]），而 HFE 对照组的低社会支持患者则没有显著变化（M = -0.8，95%CI [-7.2, 5.6]）。同样，CST 组社会支持水平较低的患者的 BDI-II 评分也有显著降低（M = -8.7，95%CI [-11.3, -6.1]），而 HFE 组的低社会支持患者的 BDI-II 评分则无明显变化（M = -3.0，95%CI [-6.0, -0.1]）。
社会支持水平较低的 HF 患者从基于电话的 CST 干预中获益显著。针对社会支持水平较低的 HF 患者进行行为干预可能是提高 QoL 和降低抑郁的一种具有成本效益的策略。
