Chacko R C, Harper R G, Gotto J, Young J
Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA.
Am J Psychiatry. 1996 Dec;153(12):1607-12. doi: 10.1176/ajp.153.12.1607.
This study prospectively investigated the relation between pretransplant assessment of psychiatric diagnosis, coping skills, and social support and outcome measures of survival and health care utilization.
Ninety-four heart transplant patients underwent structured interviews and completed a battery of self-report psychometric tests assessing coping style, health status, and psychosocial supports. Follow-up that ranged from 9 to 56 months after transplant produced a group of 63 survivors and 31 nonsurvivors, who were found to be comparable in terms of pretransplant cardiac status and severity of illness.
Survival analysis showed that dimensional psychometric measures of coping and social support based on patient self-assessment were the best significant predictors of survival. Considered separately, interview-determined ratings of social support and pretransplant compliance with treatment regimens were also potential predictors. Formal DSM-III-R diagnoses were related specifically to posttransplant hospital utilization (axis I diagnoses) and posttransplant health behavior (axis II diagnoses).
The data demonstrate the value of multifaceted assessment, since psychiatric diagnosis, coping style, and psychosocial support may contribute differently to prediction of such aspects of outcome as mortality and health care utilization.
本研究前瞻性地调查了移植前精神疾病诊断、应对技能和社会支持评估与生存及医疗保健利用结果指标之间的关系。
94名心脏移植患者接受了结构化访谈，并完成了一系列自我报告心理测量测试，以评估应对方式、健康状况和心理社会支持。移植后9至56个月的随访产生了一组63名幸存者和31名非幸存者，发现他们在移植前心脏状况和疾病严重程度方面具有可比性。
生存分析表明，基于患者自我评估的应对和社会支持的维度心理测量指标是生存的最佳显著预测指标。单独考虑时，访谈确定的社会支持评分和移植前对治疗方案的依从性也是潜在的预测指标。正式的DSM-III-R诊断分别与移植后住院利用情况（轴I诊断）和移植后健康行为（轴II诊断）相关。
数据证明了多方面评估的价值，因为精神疾病诊断、应对方式和心理社会支持可能对死亡率和医疗保健利用等结果方面的预测有不同的贡献。
