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