預防鬱症患者復發住院之門診團體治療──身心病房治療團隊外展模式

Outpatient Group Psychotherapy for Relapse Prevention Hospitalization for Major Depressive Disorder—Psychosomatic Ward-based Outreached Team Model

目的：為預防鬱症病人重複住院，南部某精神專科教學醫院身心病房團隊提供由病房團隊外展至門診開辦開團體心理治療，提供近似過渡客體情境。
方法：回顧2012年1月至2012年6月止，曾於身心病房全日住院且依健保申報ICD-9CM診斷碼為296.3鬱症診斷之重複住院個案納為分析個案共計45人。重複住院個案之定義為：進入團體前一年住院達三次（含三次）以上者。參加團體者定義為團體組，拒絕或未進入團體者定義為非團體組。其中排除9人不符合收案條件，36人符合收案條件，20人為團體組，16人為非團體組。
結果：兩組比較，統計分析發現，除教育程度在非團體組較高外（p < 0.05），其餘不論在社會人口學基本資料，進入團體後半年之總住院次數、住院總日數及出院後社區存活時間均無統計上顯著差異。若僅比較團體組參加團體前後半年之再住院次數（2.54±0.76→1.50±0.95；p = 0.01）及再住院總日數（57.90±30.46→33.30±24.49；p = 0.01），則發現參加團體後半年均顯著下降。
結論：對有意願參加團體治療者，病房團隊外展至門診之團體心理治療模式仍是一種可能降低鬱症病人再住院之可行模式。

Objective: To prevent repeated hospitalizations among patients with major depressive dosorder, a psychosomatic ward team at a psychiatric teaching hospital in southern Taiwan extended its inpatient team services to the outpatient setting by establishing group psychotherapy, providing a setting analogous to a transitional object.
Methods: A retrospective review was conducted of cases from January to June 2012. Patients who had been fully hospitalized in the psychosomatic ward and had a National Health Insurance-reported ICD-9-CM diagnosis code of 296.3 (major depressive disorder)with repeated hospitalizations were included, 45 cases in total. Repeated hospitalization was defined as three or more hospitalizations within the year prior to entering the group. Patients who participated in the group were defined as the participant group, while those who refused or did not enter the group were defined as the non-participant group. Nine patients were excluded for not meeting inclusion criteria, leaving 36 eligible cases: 20 in the participant group and 16 in the non–participant group.
Results: Comparison between the two groups showed that, except for a higher educational level in the non-participant group (p < 0.05), there were no statistically significant differences in sociodemographic characteristics including total number of hospitalizations, total length of hospital stay, or post-discharge community survival time during the six months after entering the study. However, when only the participant group was examined, both the number of rehospitalizations (2.54±0.76→1.50±0.95; p =0.01) and the total days of rehospitalization (57.90±30.46→33.30±24.49; p =0.01) during the six months after group participation showed significant decreases compared with the six months before participation.
Conclusion: For patients willing to participate in group therapy, a model in which the inpatient ward team extends group psychotherapy services to the outpatient setting may be a feasible approach to reducing rehospitalization among patients with major depressive disorder.