Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
Department of Psychological Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Neurogastroenterol Motil. 2021 Feb;33(2):e13956. doi: 10.1111/nmo.13956. Epub 2020 Jul 27.
Psychological factors contribute to the pathogenesis of functional dyspepsia (FD). Antidepressant agents are beneficial in treatment of refractory FD. However, their efficacy is greatly hindered by the poor treatment adherence. Stigma is present in patients with chronic diseases or mental disorders and could affect adherence. The present study was aimed to evaluate stigma prevalence in FD patients and to explore the impact of stigma on treatment adherence to antidepressants.
Functional dyspepsia patients unsatisfied with the regular first-line treatment and received newly initiated antidepressant medicine were recruited and subjected to antidepressant treatment for 8 weeks. Stigma scales and symptom scores of dyspepsia, depression, and anxiety were analyzed before and after treatment. Associations between stigma and medication adherence were evaluated.
One hundred and ten of the enrolled 138 participants reported minimal disease-related internalized stigma, and 28 reported mild stigma before antidepressant therapy. Male gender, lower education, and higher scores of dyspepsia, depression, and anxiety were predictors of stigma before treatment. The mean stigma scores increased after 8-week antidepressant treatment. A proportion (36.4%-89.9%) of patients showed stigma attached to antidepressant therapy in the 4-question survey. Post-treatment stigma scores negatively correlated with treatment adherence and efficacy. Patients with decreased post-treatment stigma scores displayed better medication adherence and symptom improvement compared to those with elevated or unaltered post-treatment stigma scores.
Patients with refractory FD report stigma attached to the disease and antidepressants. It is an obstacle to treatment adherence and efficacy of antidepressant medication in FD therapy.
心理因素与功能性消化不良（FD）的发病机制有关。抗抑郁药对难治性 FD 的治疗有益。然而，由于治疗依从性差，其疗效受到很大阻碍。慢性病或精神障碍患者存在耻辱感，可能会影响治疗依从性。本研究旨在评估 FD 患者的耻辱感发生率，并探讨耻辱感对抗抑郁药治疗依从性的影响。
招募对常规一线治疗不满意并接受新启动的抗抑郁药物治疗的功能性消化不良患者，并接受 8 周的抗抑郁治疗。在治疗前后分析了耻辱感量表和消化不良、抑郁、焦虑的症状评分。评估了耻辱感与药物依从性之间的关系。
在纳入的 138 名参与者中，有 110 名报告了最小的与疾病相关的内化耻辱感，有 28 名在接受抗抑郁治疗前报告了轻度耻辱感。治疗前，男性、较低的教育程度以及更高的消化不良、抑郁和焦虑评分是耻辱感的预测因素。经过 8 周的抗抑郁治疗后，平均耻辱感评分增加。在 4 个问题的调查中，有一定比例（36.4%-89.9%）的患者对抗抑郁治疗存在耻辱感。治疗后耻辱感评分与治疗依从性和疗效呈负相关。与治疗后耻辱感评分升高或不变的患者相比，治疗后耻辱感评分降低的患者显示出更好的药物依从性和症状改善。
难治性 FD 患者报告了与疾病和抗抑郁药相关的耻辱感。它是 FD 治疗中治疗依从性和抗抑郁药物疗效的障碍。
