药物治疗管理对不同年龄段女性抑郁症患者效果的分层随机对照研究

Effects of Medication Therapy Management for Female Depressed Patients of Different Ages: A Stratified Randomized Controlled Trial

关键词:  女性  抑郁症  药物治疗管理  抑郁自评量表  药物依从性

Key words:  female  depression  medication therapy management  self-rating depression scale  medication adherence

摘要:

目的 评估实施药物治疗管理(medication therapy management，MTM)对女性抑郁症患者症状改善及用药依从性的影响，探讨不同年龄段女性患者的抑郁严重程度及依从性特点。方法 选取2022年2—7月就诊的女性抑郁症患者180例，根据不同年龄段和抑郁程度分层随机分为对照组和管理组各90例。对照组给予常规诊疗，管理组在常规诊疗基础上实施MTM。分别于入组时及3个月后采用Zung抑郁自评量表(self-rating depression scale，SDS)评估2组患者的抑郁症状，分别于入组4，8，12周末采用MMAS-8量表比较2组患者的依从性差异，并根据分层因素进行亚组分析。结果 147例患者完成所有的测评和随访，对照组和管理组脱落率差异无统计学意义(χ²=3.006，P=0.083)，不同抑郁严重程度脱落者与未脱落者比较，差异具有统计学意义(χ²=13.927，P=0.001)。不同年龄段SDS评分比较：治疗前、后均以青春期最高、更年期次之、育龄期最低，差异均有统计学意义(P＜0.05)。管理组和对照组SDS评分比较：管理组不同年龄段各亚组以及不同严重程度各亚组的SDS评分均低于对照组相应组别，除更年期亚组及轻度亚组外，差异均有统计学意义(P＜0.05)。176例患者依从性总体评分为(5.69±1.37)分。不同年龄段依从性特点：全程评估育龄期最高，青春期次之，更年期最低，差异有统计学意义(χ²=6.61，P=0.037)。管理组和对照组依从性评分比较：3个年龄段管理组依从性评分均高于相应对照组，全程评估青春期(χ²=25.573，P＜0.001)，育龄期(χ²=7.772，P=0.005)，更年期(χ²=19.776，P＜0.001)，差异均有统计学意义；除育龄期在第1次和第2次随访外，3个年龄段3次随访管理组和对照组差异均有统计学意义(P＜0.05)。结论 女性抑郁症患者不同年龄段的严重程度存在差异，以青春期最重、育龄期最轻；用药依从性水平整体较低，以育龄期最高，更年期最低。MTM能有效促进不同年龄段女性患者抑郁症状改善及依从性提升。

Abstract:

OBJECTIVE To assess the effect of medication therapy management(MTM) on symptom improvement and medication adherence in depressed female patients, and to explore the depression severity and adherence characteristics of female patients of different ages. METHODS A total of 180 female depressed patients from February 2022 to July 2022 were recruited and randomly divided into two groups according to age and depression severity: the control group and the management group,with 90 cases in each group. Patients in the control group were given conventional therapy, while those in the management group were given MTM on top of conventional therapy. The self-rating depression scale(SDS)was applied at enrollment and 3 months after treatment to assess symptom improvement in both groups, and the Morisky Medication Adherence Scale- 8(MMAS-8) was applied at the end of 4, 8 and 12 weeks of treatment to compare adherence differences between the two groups, and subgroup analysis was performed based on stratification factors. RESULTS A total of 147 patients completed all assessments and follow-up, and there was no statistically significant difference in drop-out rate between the control group and the management group(χ²=3.006, P=0.083). Patients who dropped-out with different depression severity were compared with those who did not, with a statistically significant difference(χ²=13.927, P=0.001). For the comparison of SDS scores by age group, the highest SDS scores before and after treatment were found in adolescence, followed by menopause, and the lowest in childbearing age, with statistically significant differences(P＜0.05). The SDS scores of each subgroup of different age groups and each subgroup of different depression severity in the management group were lower than those of the corresponding groups in the control group, with statistically significant differences except for the menopausal subgroup and the mild subgroup(P＜0.05). The overall compliance score of 176 patients was (5.69±1.37) points. In the full assessment the adherence scores were the highest in childbearing, followed by adolescence, and the lowest and the lowest in menopause, with statistically significant difference(χ²=6.61, P=0.037). The adherence scores of the different age groups were higher in the management group than those in the control group,with statistically significant differences in adolescence(χ²=25.573, P＜0.001), childbearing age(χ²=7.772, P=0.005)and menopause(χ²=19.776, P＜0.001) for the full assessment. Except for the 1st and 2nd follow-up in childbearing age, there were statistically significant differences between management group and control group at three age groups in the three follow-up visits(P＜0.05). CONCLUSION The depression severity in female depressed patients varies by age, with the heaviest in adolescence and the least severe in childbearing age. The overall level of medication adherence is low in female patients. The adherence is highest in childbearing age and lowest in menopause. MTM boasts to be effective in promoting symptom improvement and adherence in female depressed patients of different ages.