Yan Xiu-Juan, Qiu Hong-Yi, Luo Qing-Qing, Wang Bo, Xu Ping, Ji Chen-Feng, Chen Sheng-Liang
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.
J Neurogastroenterol Motil. 2022 Jan 30;28(1):95-103. doi: 10.5056/jnm20239.
BACKGROUND/AIMS: Antidepressants are effective in patients with functional dyspepsia (FD). However, stigma associated with FD and antidepressants may affect treatment adherence. This study aims to explore possible communication strategies to alleviate stigma and improve adherence in patients with FD.
In this randomized, single-center, and single-blind trial, 160 patients with FD initiating antidepressant treatment were recruited. Different communication strategies were performed when prescribing antidepressants. Participants in Group 1 were told that brain is the "headquarters" of gut, and that antidepressants could act as neuromodulators to relieve symptoms of FD through regulating the functions of gut and brain. Participants in Group 2 were told that antidepressants were empirically effective for FD. Stigma scores, medication-related stigma, treatment compliance, and efficacy were analyzed.
After 8-week antidepressant treatment, the proportion of patients with FD with decreased stigma scores in Group 1 was significantly higher than in Group 2 (internalized stigma: 64.10% vs 12.00%; perceived stigma: 55.13% vs 13.33%; < 0.01). Medication-related stigma was lower in Group 1 than in Group 2 ( < 0.05 for 3 of 4 questions). Concurrently, patients in Group 1 had better treatment compliance (0.71 ± 0.25 vs 0.60 ± 0.25, < 0.01) and efficacy. In Group 1, participants with decreased post-treatment stigma scores showed better treatment compliance and efficacy than those with non-decreased scores. Decrease in stigma scores positively correlated with treatment compliance.
Improving knowledge of patients with FD of the disease and antidepressants via proper communication may be an effective way to alleviate stigma and promote adherence.
背景/目的：抗抑郁药对功能性消化不良（FD）患者有效。然而，与FD和抗抑郁药相关的污名可能会影响治疗依从性。本研究旨在探索可能的沟通策略，以减轻污名并提高FD患者的依从性。
在这项随机、单中心、单盲试验中，招募了160例开始抗抑郁治疗的FD患者。在开具抗抑郁药时采用了不同的沟通策略。第1组的参与者被告知大脑是肠道的“司令部”，抗抑郁药可作为神经调节剂，通过调节肠道和大脑的功能来缓解FD症状。第2组的参与者被告知抗抑郁药对FD经验证有效。分析了污名得分、与药物相关的污名、治疗依从性和疗效。
经过8周的抗抑郁治疗后，第1组FD患者污名得分降低的比例显著高于第2组（内化污名：64.10%对12.00%；感知污名：55.13%对13.33%；P<0.01）。第1组与药物相关的污名低于第2组（4个问题中的3个P<0.05）。同时，第1组患者的治疗依从性更好（0.71±0.25对0.60±0.25，P<0.01）且疗效更佳。在第1组中，治疗后污名得分降低的参与者比得分未降低的参与者具有更好的治疗依从性和疗效。污名得分的降低与治疗依从性呈正相关。
通过适当的沟通提高FD患者对疾病和抗抑郁药的认识，可能是减轻污名并促进依从性有效的方法。
