问题管理家对老年慢性疾病患者抑郁、焦虑情绪的干预

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	问题管理家对老年慢性疾病患者抑郁、焦虑情绪的干预
其他题名	Intervention of Problem Management Plus on depression and anxiety in elderly patients with chronic diseases
	王靖伊
导师	刘正奎
	2022-06
摘要	身体机能衰减、退休、丧失等生活事件会导致老年群体的压力增加，而慢性疾病又进一步加重老年人负担，因此老年慢性病患者的心理健康状况亟需重视。本研究将采用一种低强度、跨诊断的非专家心理干预方法“问题管理家”(Problem Management Plus, PM+)对老年慢性病患者进行干预。PM+融合了认知行为疗法中的压力管理、问题管理、行为激活、社会支持四种策略，以帮助老年人学会更好地应对和管理问题。本研究包括三部分。研究一旨在了解老年慢性病患者群体的心理健康特点，以便培训 PM+实施者提高干预针对性。在合肥市某医院对 55 岁及以上、患一种或多种慢性疾病的老年人展开问卷调查（N=209，平均年龄为 68.8 岁），收集人口学信息、健康状况、心理健康等数据。结果发现，样本受教育程度和生活经济水平偏低。抑郁症、焦虑症的检出率为 12.4%，女性的抑郁症、焦虑症的检出率是男性的两倍及以上。不同年龄段老年慢性病患者的心理健康程度无显著差别。研究二通过随机对照实验探究 PM+对老年慢性病患者干预的有效性。当地五名助人者接受 PM+培训，并通过考核。在前期问卷调查中，活动机能不良且抑郁焦虑情绪达到中度及以上的被试，被邀请参与 PM+干预活动。被试被随机分为干预组（n=24）和等待组（n=24），干预组按照 PM+流程，和助人者每周进行一次会面，共五次；等待组进行了两次针对身体健康方面的信息的电话沟通。六周后，对被试再次进行问卷调查。结果发现，PM+对于降低老年慢性疾病患者的抑郁、焦虑情绪的效果非常显著，但未显著改变活动机能损伤。研究三对五名助人者进行半结构化访谈，进一步探索 PM+的有效因素和适用性。研究发现，PM+在中国城镇语境下老年群体的适用性整体较好，其中减压、社交支持策略的效果突出，行为激活策略不适用，问题管理策略效果良好，但PM+对助人者的要求较高，如最好有与老年人打交道的丰富经历。PM+的老年专用版，可从增加保健技巧、纳入监护人参与、采用团体辅导形式等方面对原版进行改进。
其他摘要	Agedness is often related to declined physical functions, retirement, and loss, leading to increased stress and reduced resources. More attention is needed to the mental health of elderly patients with chronic diseases. Problem Management Plus (PM+), a low-intensity, cross-diagnostic, non-expert psychological intervention for elderly patients with chronic diseases, will be used in this study. PM+ integrates four strategies from cognitive behavioral therapy, aiming to help the elderly learn how to better cope with and manage problems. This study will explore the effect of PM+ intervention on elderly patients with chronic diseases and how to better implement this intervention. This study consists of three parts. Study 1 aims to understand the mental health characteristics of elderly patients with chronic diseases so that PM+ helpers can be trained accordingly to make the PM+ intervention more targeted. Study 1 was conducted in a hospital in Hefei among patients 55 years old or older with one or more chronic diseases (N = 209, mean age of 68.8 years). This part collected data via questionnaire, including demographic information, health conditions, and mental health level. Results showed that the samples had low educational achievements and low household incomes. The detection rate of depression and anxiety was 12.4%, and the detection rate of depression and anxiety in women was twice or more than that in men. There was no significant difference in the mental health degree of chronic disease patients in the same age group. Study 2 aims to explore the effectiveness of PM+ intervention in elderly patients with chronic diseases through randomized controlled trials. Five local helpers were provided with PM+ training and passed the assessment. As indicated in the questionnaire in study 1, Subjects with impaired activity and a certain degree of depression and anxiety were invited to participate in PM+ intervention activities to improve their mental health. The subjects were randomly divided into the intervention group (n=24) and the waiting group (n=24). Each subject in the intervention group was paired up with one local helper for weekly individual counseling face to face five times in total. The subjects in the waiting group were interviewed for physical health via phone calls. Six weeks later, data were collected again for both groups. In general, PM+ had a significant effect on reducing depression and anxiety in elderly patients with chronic diseases, but there was no significant change in activity impairment. Study 3 adopted the qualitative research method as the five helpers conducted semi- structured interviews among the subjects to further explore the effective factors and applicability of PM+. The results showed that PM+ was generally suitable for the elderly in Chinese cities and towns. Among the PM+ strategies, decompression and social support strategies demonstrated prominent effects, while behavioral activation strategies are not applicable. Problem management strategies worked well, but they could only be used by individuals skilled in working with the elderly. If PM+ launches a specialized version for the elderly, it could integrate health care skills, involvement of their legal guardians, and group counseling services.
关键词	问题管理家老年群体慢性疾病抑郁焦虑
学位类型	硕士
语种	中文
学位名称	理学硕士
学位专业	应用心理
学位授予单位	中国科学院大学
学位授予地点	中国科学院心理研究所
文献类型	学位论文
条目标识符	http://ir.psych.ac.cn/handle/311026/43195
专题	应用研究版块
推荐引用方式 GB/T 7714	王靖伊. 问题管理家对老年慢性疾病患者抑郁、焦虑情绪的干预[D]. 中国科学院心理研究所. 中国科学院大学,2022.

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文件名称/大小	文献类型	版本类型	开放类型	使用许可
王靖伊-问题管理家对老年慢性疾病患者抑郁（2018KB）	学位论文		限制开放	CC BY-NC-SA	请求全文