促進憂鬱症病患正確就醫用藥行為－－以病友團體模式評估成效

Improving Medical Help--Seeking Behavior for Depressive Patients-Evaluation of the Efficacy of a Health Education and Peer Group Course

目的：憂鬱症是一常見且影響身心健康甚鉅的精神疾病，因此世界衛生組織將憂鬱症列為二十一世紀人類三大疾病之一。台灣地區民國91年國人十大死因統計發現，自殺排名第九，而自殺與憂鬱症有著密切的關係，因此憂鬱症已成為台灣公共衛生界之一大課題。然而大部份國人對憂鬱症仍缺乏正確的認知，或深受精神疾病污名化（stigma）的影響而排斥就醫或將之視為身體疾病遊走於各科之間，使得憂鬱症沒有得到適當的治療，造成醫療資源的浪費，以及家庭、社會沈重的負擔。本計畫即針對憂鬱症病友設計一個短期的課程，結合衛生教育、放鬆訓練及成長團體的模式，以達到促進憂鬱症病患正確就醫用藥行為的目的，進而改善病情，提高疾病康復率。方法：共有12位過去或現在曾罹患有憂鬱症的病友參加為期6週的衛教及成長團體並完成團體課程。團體前後並由同一位醫師給予個別會談評估並使用漢米爾頓憂鬱量表（Hamilton Depression Rating Scale, HDRS）、12題版中國人健康量表（Chinese Health Questionnaire-12, CHQ-12）及自製之憂鬱症常識測驗（Depression Common Sense Test DCST）等進行前後測。結果：團體前後之量表得分分別為：HDRS:10.33±6.18（團體前），8.00 ± 3.93（團體後），p=0.03*；CHQ-12 : 3.83 ± 3.01（團體前），2.67 ± 2.77（團體後），p=0.177；常識測驗：80.83 ± 5.57（團體前），86.25 ± 8.56（團體後），p=0028*。其中HDRS與常識測驗的進步達到顯著差異。結論與建議：短期衛教及成長團體模式可用來做為促進憂鬱症患者對疾病正確的認知並改善病情，以加強藥物療效及彌補門診衛教之不足。

Objective: Depressive disorder is one of the most common and influential psychiatric illnesses and is listed, therefore, as one of the three major human diseases of the 21st century by the World health Organization. In the statistical evidence of the 10 major causes of death in Taiwan in 2002, death by suicide is listed as the ninth leading cause. Since depression correlates with suicide, depressive disorder has become one of the major public health issues in Taiwan. However, most of people lack a correct understanding of depressive disorder and depressive patients suffer under the stigma of psychiatric illness and hesitate to seek medical help. Accordingly, depressive patients don't acquire appropriate treatment, causing a waste of medical resources, and increasing the burden of the family and society. In this study, a short-term group therapy for depressive patients was designed, consisting of health education, muscle relaxation training, emotional sharing and peer support, aimed at improving their behaviorin correctly seeking medical help and raising the recovery rate of patients with depressive disorder. Method: In all, 12 depressive patients completed the 6-weel health education and peer group course. Every individual patient was interviewed and evaluated by the same doctor using the HDRS, CHQ-12 and the Depression Common Sense Test (DCST) before and after the course. Result: The score of the scales before and after the course were: HDRS: 10.33 ± 6.18 (before), 8.00 ± 3.93 (after), p=0.03*; CHQ-12: 3.83 ± 3.01 (before), 2.67 ± 2.77 (after), p=0.177; DCST: 80.83 ± 5.57 (before), 86.25 ± 8.56 (after), p=0.028*. Significant differences were found in the HDRS and DCSI scores. Conclusion: The short-term health education and peer group course enhanced the appropriate behaviors in seeking medical help by improving the patients' cognition of the depressive disorder thus augmenting the efficacy of the antidepressant drugs and compensating for the insufficiency of out-patient department education.