Black J L, Allison T G, Williams D E, Rummans T A, Gau G T
Department of Psychiatry and Psychology, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Psychosomatics. 1998 Mar-Apr;39(2):134-43. doi: 10.1016/S0033-3182(98)71360-X.
Psychosocial factors affect the development of coronary heart disease and morbidity and mortality of patients with known coronary heart disease. A prior study has shown that psychological distress in patients with known coronary heart disease increased medical and economic costs. This study examined the effects of commonly available psychological interventions offered to patients entering cardiac rehabilitation after hospitalization for angina, myocardial infarction, angioplasty, or coronary artery bypass grafting. A total of 380 patients were screened with the Symptom Checklist-90-Revised (SCL-90-R). Those with T-scores > or = 63 (> or = 91 percentile) on the General Severity Index (GSI) subscale were randomly assigned to usual care or special intervention. Special intervention included a psychiatric evaluation, plus one to seven sessions of behavioral therapy. The percentage of patients rehospitalized for cardiac symptoms within 12 months of psychological evaluation was 43% for special intervention and 40% for usual care (NS). A correction for crossover between the treatment groups resulted in a favorable trend toward intervention, with 35% of the psychologically treated patients rehospitalized vs. 48% of the untreated patients (NS). Although there was a nonsignificant reduction of the SCL-90-R's GSI T-score, the depression score was significantly reduced in the special intervention group.
社会心理因素会影响冠心病的发展以及已知冠心病患者的发病率和死亡率。先前的一项研究表明，已知冠心病患者的心理困扰会增加医疗和经济成本。本研究考察了为因心绞痛、心肌梗死、血管成形术或冠状动脉搭桥术后住院而进入心脏康复项目的患者提供的常见心理干预措施的效果。共有380名患者接受了症状自评量表-90修订版（SCL-90-R）筛查。在一般严重程度指数（GSI）分量表上T分数≥63（≥第91百分位数）的患者被随机分配至常规护理组或特殊干预组。特殊干预包括一次精神科评估，外加一至七次行为治疗。在心理评估后的12个月内，因心脏症状再次住院的患者比例，特殊干预组为43%，常规护理组为40%（无显著差异）。对治疗组之间的交叉情况进行校正后，出现了有利于干预的趋势，接受心理治疗的患者中有35%再次住院，未接受治疗的患者中有48%再次住院（无显著差异）。虽然SCL-90-R的GSI T分数有不显著的降低，但特殊干预组的抑郁分数显著降低。
