【作者】 王源莉；

【导师】 李淑英；

【作者基本信息】 郑州大学 ， 精神学与精神卫生学， 2012， 硕士

【摘要】 青少年抑郁症是一种常见精神疾病,其患病率呈不断上升和发病年龄更小的趋势,且终身患病率达到15-20%,接近于成人,而有关研究也认为成年期抑郁症在青少年时期已发病。抑郁症的发生影响因素有很多,青少年作为一个特殊的社会群体,正处于人生观、价值观形成的关键时期,经常面临学习压力过大,人际关系敏感、家庭因素等多种应激性事件,而解决此方面问题的能力较差,容易形成自尊心、自信心下降,出现我不能、我不行等一系列负性思维模式,表现为消极、被动和自我为中心。由于抑郁症具有复发率高、自杀危险度高、病程长等特点,因此预防复发、完善其社会功能,使之真正达到心理康复是治疗的重要目标,而有关抑郁症治疗方面的研究也越来越趋于药物与心理治疗的综合治疗,综合治疗不仅可以减轻或缓解患者的抑郁症状,还可以提高其心理社会适应功能水平,改善其生活质量。因此探讨其影响因素以及综合治疗已成为当今重要课题。尽管国内外已有关于抗抑郁剂联合认知行为疗法治疗抑郁症方面的研究,但应用于青少年方面的研究仍相对较少。本研究在前期研究工作的基础上,结合青少年抑郁症的特点,以观察其社会心理因素及舍曲林联合认知行为疗法治疗的临床疗效。目的1.探讨青少年抑郁症患者社会心理因素。2.探讨舍曲林联合认知行为疗法治疗青少年抑郁症的临床疗效。方法1.研究对象：包括抑郁症组(90例)和正常对照组(114例),将抑郁症组进一步分为联合治疗组(45例)与单用舍曲林组(45例)。2.研究工具：自制一般资料调查表、汉密尔顿抑郁量表(Hamiltion Depression Scale, HAMD)、汉密尔顿焦虑量表(Hamiltion Anxiety Scale, HAMA)、症状自评量表(Rating Symptom Scale, SCL-90)、艾森克人格问卷(Eysenck Personality Questionnaire, EPQ问卷)、简易应对方式量表(SimplifiecopingStyle questionnaire, SCSQ)、家庭环境量表(Family Environment Scale,FES-CV)、健康状况(Scores of health-related quality of life scale, SF-36)。3.入组时进行上述量表评定,抑郁症组于治疗的2、4、6、8周末再次评定HAMD、HAMA、SCL-90以评定疗效,同时在8周治疗结束时再次给予EPQ、FES-CV、SCSQ、SF-36量表评定。4.认知行为疗法治疗由我科专业心理咨询师进行,在患者知情同意前提下,结合其人格特征、人际关系、临床症状等进行综合判断,形成结构化的治疗计划、日程设置,采用负性自动思维识别、家庭作业及其检查等方法挖掘患者的不合理信念,并以理性信念取代非理性信念,从而改善其不良情绪、歪曲认知。结果1.与正常对照组相比,抑郁症组神经质(t=8.49p<0.01)、精神质(t=12.15p<0.01)得分较高,内向性(t=7.53p<0.01)得分较低。2.与正常对照组相比,抑郁症组矛盾性(t=6.31p<0.01)得分较高,独立性(t=-11.13p<0.01)；情感表达(t=-11.61p<0.01)、亲密度(t=-20.48p<0.01)、成功性(t=-9.64p<0.01)、娱乐性(t=-16.25p<0.01)、组织性(t=-12.08p<0.01)、控制性(t=-15.27p<0.01)、知识性(t=-16.95p<0.01)、道德宗教观(t=-14.15p<0.01)得分较低。3.与正常对照组相比,抑郁症组消极应对方式(t=8.02p<0.01)得分较高,积极应对方式(t=-2.86p<0.01)得分较低。4.联合治疗组与单用舍曲林组相比,联合治疗组治疗8kw后t检验示：EPQ各维度均有差异,神经质(t=-3.46p<0.05)、精神质(t=-2.88p<0.05)低于单用舍曲林组,内外向得分(t=-0.26p<0.05)高于单用舍曲林组。5.联合治疗组积极应对方式得分(t=-5.13p<0.01)高于单用舍曲林组,消极应对方式得分(t=-7.43p<0.01)低于单用舍曲林组。6.联合治疗组与单用舍曲林组组间比较,经秩和检验示：治疗2kw后HAMA得分显著降低(p<0.01),治疗4kw后SCl-90、HAMD得分降低(p<0.05)。7.联合治疗组与单用舍曲林组组内比较,经秩和检验示：治疗2kw后SC1-90、HAMD、HAMA得分降低(p<0.05)。治疗8kw后SCl-90、HAMD、HAMA得分显著降低(p<0.01)结论根据本项研究可得出以下结论：1.家庭环境中的矛盾性,人格中的神经质、精神质、内向性,应对方式中的消极应对是青少年抑郁症的社会心理影响因素。2.与单用舍曲林相比,联合认知行为治疗能更有效缓解患者的抑郁症状。更多还原

【Abstract】 Adolescents with major depression is a kind of common mental disease, its prealence was rising and age of onset of smaller trend, and lifetime prealence hit15-20%, close to an adult, and the relevant research also think adulthood depression was a teenager already comes on. The influence of the depression happened there are many factors, adolescents as a special social group, is in the key period of outlook on life values, often face learning pressure is too great, sensitive interpersonal relationship family factors and so on many kinds of stressful thing, and solving the problems of ability is bad, easy to form self-esteem, self-image, appear I can’t I not and so on a series of negative thinking mode, for the performance of the passive and self-centered. Depression has the recurrence rate high suicide risk high course is long, etc, thus to prevent recurrence perfect its social function, the psychological recovery is really achieve important goal of treatment, and the treatment of depression research also more drugs and psychotherapy treatment, comprehensive treatment can not only reduce or ease the symptoms of depression patients, but also can improve its psychological adapt functional level, and improve the quality of life so, discusses the influence factors and comprehensive treatment of the relationship between the has become an important subject today.Although at home and abroad, about antidepressants joint cognitive behavioral therapy for the treatment of depression, but used in youth research is still relatively small this study in the work, and on the basis of the characteristics of the depression with adolescents in order to observe its effect factors and gave sertraline combined cognitive behavioral therapy the clinical efficacy of treatment.Objectives1. Discusses the socio-psychological factors of adolescents depressed patients.2. Explore sertraline combined cognitive behavioral therapy in the treatment of adolescent depression of the clinical curative effect.Methods1. Object of study Including depression group (n=90) and normal control group (n=114), will be the depression group further divided into the combined treatment group (n=45) with those pieces of sertraline (n=45).2. Research Instruments Self-made questionnaire the general information, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale Rating Symptom Scale (HAMA), Eysenck Personality Questionnaire (EPQ), SimplifiecopingStyle Questionnaire (SCSQ), Family Environment Scale (FES-CV), Scores of health-related quality of life Scale (SF-36).3. When the group above assessment scale, cases in depression group of2,4,6,8weekend evaluation HAMD, HAMA, SCL-90again to assess curative effect, at the same time in eight weeks at the end of the treatment again give EPQ, FES-CV, SCSQ, SF-36scale evaluation.4. Cognitive behavioral therapy, by my professional psychological consultants, informed consent in patients premise, combined with its personality traits interpersonal clinical symptoms of comprehensive judgments, form structured treatment plan set schedule, the negative automatic identification of homework and thinking methods of patients with mining check is not reasonable faith, and faith in rational replace irrational belief, so as to improve its bad mood cognitive distortion. Results1. Compared with the normal control group, the depression group has neurotic (t=8.49p<0.01), psychoticism (t=12.15p<0.01) score higher, endocathection (t=7.53p<0.01)score is low.2. Compared with the normal control group, the depression group contradiction (t=6.31p<0.01)score higher, independence (t=11.13p<0.0l), emotional expression (t=11.61p<0.01), intimacy (t=20.48p<0.01), achievement,(t=9.64p<0.01), entertaining (1=16.25p<0.01), organized (t=12.08p<0.01), controlling (t=15.27p<0.01) knowledge (t=16.95p<0.01), moral-religious emphasis(t=14.15p<0.01) scored lower.3. Compared with the normal control group, the depression group negative coping styles (t=8.02p<0.0l) score higher, positive coping styles(t=-2.86p<0.01) score is low.4. Combined treatment group compared with those pieces group, the8wk began to appear combined treatment group t test after the show:EPQ dimensions are differences, neurotic (t=3.46p<0.05), psychology (t=2.88p<0.05) less than those sertraline group, inside and outside to give score (t=0.26p<0.05) than those sertraline group up.5. SCSQ combined treatment group in positive way to deal with the score (t=5.13p<0.01) than those sertraline in group, gave way to deal with the negative points (t=7.43p<0.01) less than those sertraline group up.6. Combined treatment group up with those sertraline group comparison among groups, Wilcoxon after the show:2kw HAMA after treatment were significantly reduced (p<0.01), treatment after4kw SCl-90, HAMD score lower (p＜0.05).7. Combined treatment group up with those sertraline comparison in the group, Wilcoxon after the show:treatment after2kw SC1-90, HAMD, HAMA score lower0<0.05). Treatment after8kw SCl-90, HAMD, HAMA score significantly reduced (p<0.01). ConclusionsAccording to this study can be concluded:1. The contradiction between family environment, the neurotic personality, psychology, endocathection, the way to deal with the negative coping is adolescents the socio-psychological factors of depression.2. Compared with those sertraline pieces, combined cognitive behavioral therapy can be more effective relieve the symptoms of depression patients.更多还原