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基于正念认知疗法治疗退伍军人精神障碍的治疗参与和结果。

Treatment Engagement and Outcomes of Mindfulness-Based Cognitive Therapy for Veterans with Psychiatric Disorders.

机构信息

Whole Health Service, VA Salt Lake City Health Care System, Salt Lake City, UT.

Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT.

出版信息

J Altern Complement Med. 2019 Sep;25(9):902-909. doi: 10.1089/acm.2018.0511. Epub 2019 Jul 19.

Abstract

The aim of this study was to evaluate utilization and outcomes of mindfulness-based cognitive therapy (MBCT) provided to veterans with psychiatric disorders. Retrospective chart review. Veterans Administration Medical Center (VAMC). Ninety-eight veterans with psychiatric illness who were enrolled in an MBCT class between May of 2012 and January of 2016. Subjects were predominately white (95%), male (81%), and >50 years old (74%). The most common psychiatric conditions were any mood disorder (82%) and post-traumatic stress disorder (54%). Eight-week MBCT class. Session attendance and pre- to postintervention changes in numbers of emergency department (ED) visits and psychiatric hospitalizations. The average number of sessions attended was 4.87 of 8 and only 16% were present for all sessions. Veteran demographic variables did not predict the number of MBCT sessions attended. However, both greater numbers of pre-MBCT ED visits ( = 0.004) and psychiatric admissions ( = 0.031) were associated with attending fewer sessions. Among patients who experienced at least one pre- or post-treatment psychiatric admission in the 2 years pre- or postintervention ( = 26, 27%), there was a significant reduction in psychiatric admissions from pre to post ( = 0.002). There was no significant change in ED visits ( = 0.535). MBCT may be challenging to implement for veterans with psychiatric illness in, at least some, outpatient VAMC settings due to a high attrition rate. Possible mediation approaches include development of methods to screen for high dropout risk and/or development of shorter mindfulness-based interventions (MBIs) and/or coupling MBIs with pleasurable activities. The finding of a significant decrease in psychiatric hospitalizations from pre- to post-MBCT suggests that prospective studies are warranted utilizing MBCT for veterans at high risk for psychiatric hospitalization.

摘要

本研究旨在评估为患有精神障碍的退伍军人提供正念认知疗法 (MBCT) 的利用情况和结果。回顾性图表审查。退伍军人管理局医疗中心 (VAMC)。2012 年 5 月至 2016 年 1 月期间参加 MBCT 课程的 98 名患有精神疾病的退伍军人。受试者主要为白人(95%)、男性(81%)和 >50 岁(74%)。最常见的精神疾病是任何情绪障碍(82%)和创伤后应激障碍(54%)。为期 8 周的 MBCT 课程。出席人数和参加干预前后急诊室(ED)就诊次数和精神科住院人数的变化。出席的平均课程数为 8 节中的 4.87 节,只有 16%的人参加了所有课程。退伍军人的人口统计学变量不能预测 MBCT 课程的出席人数。然而,MBCT 前的 ED 就诊次数( = 0.004)和精神科入院次数( = 0.031)越多,出席的课程越少。在干预前后 2 年内至少经历过一次治疗前或治疗后精神科入院的患者中( = 26,27%),精神科入院人数从治疗前到治疗后显著减少( = 0.002)。ED 就诊次数无显著变化( = 0.535)。MBCT 可能难以在退伍军人精神科门诊 VAMC 环境中实施,因为退伍军人的流失率很高。可能的中介方法包括开发筛选高辍学风险的方法和/或开发更短的正念干预(MBIs)和/或将 MBIs 与愉快的活动相结合。从 MBCT 前到 MBCT 后精神科住院率显著下降的发现表明,有必要对高危精神科住院的退伍军人进行前瞻性研究,以利用 MBCT。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b26e/6748402/e477fc698ac1/fig-1.jpg

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