The theoretical system of systematic family therapy has been introduced into China for 17 or 18 years, and the treatment or improved treatment methods using its theoretical system have been used in the recovery of schizophrenia, and have achieved good results. In this experiment, we attempted to use its theories in combination with the psychological characteristics of Chinese families to adopt an integrated family therapy approach in the treatment of depression.
1. Subjects and methods
Subjects: Depressed patients in Zhengzhou Eighth People’s Hospital who met the diagnostic criteria for depression of the Chinese Classification and Diagnosis of Mental Disorders, 3rd edition (CCMD-3) were selected as subjects. The patients lived in Zhengzhou city and had immediate family members living with them, and had no serious physical illness. There were 92 cases who met the above criteria, of which 76 cases (82.6) were willing to participate in the experiment and 16 cases (17.4) refused to participate in the experiment.
They were randomly divided into experimental and control groups according to a random number table. In the experimental group, there were 14 males and 25 females, mean age (36.02±5.61) years, age of first onset (28.2±6.8) years, duration of disease (5.6±5.4) years, number of hospitalizations (2.1±2.8), and years of reading (11.2±2.4) years. In the control group 3, there were 13 males and 24 females, mean age (35.08±5.71) years, age of first onset (27.9±6.7) years, duration of illness (5.9±5.8) years, number of hospitalizations (2.2±2.6) and years of reading (10.8±5.8) years. The differences between the two groups for each of the above variables were not significant and were well comparable.
METHODS: INTERVENTION METHODS: Initial doctor-patient relationship was established by meeting with the family members of the experimental group while the patients were in the hospital, but no intervention was made during hospitalization. After discharge, the experimental group received home treatment and the control group received general outpatient treatment.
The family therapy in this project was developed by combining the psycho-behavioral characteristics of Chinese families and referring to foreign psychotherapy theories such as family system model, psycho-educational model, and cognitive-behavioral model. There are two stages: active intervention and maintenance treatment. The course of active intervention is usually 1.5 to 2 years, with medication, psychoeducation and family intervention as the main means. The primary therapist is a physician who is familiar with family therapy techniques.
Assessment tools and methods: The Hamilton Depression Scale (HAMD) was used to evaluate clinical symptoms. Clinical outcome was assessed with the Clinical Global Inventory-Summary Assessment of Outcome Scale (CGI-SI). Patients’ social functioning was evaluated with a modified Social Functioning Deficit Screening Scale (SDSS-R) [4]. The severity of patients’ social functioning deficits in the last six months was described by the percentage of the revised Social Functioning Deficits Screening Scale score (0 being the best and 100 being the worst).
Evaluation of family burden: key relatives were asked to evaluate the degree of impact of the disease on family life in the last six months in six dimensions (0: no impact, 1: mild, 2: moderate, 3: severe).
Detailed human data were collected and patients’ clinical symptoms were evaluated at admission. Patients’ clinical symptoms were evaluated again at the time of discharge. Clinical symptoms, social functioning, impact on family, medication, work and rehospitalization were assessed every 6 months after discharge. The assessment was done by a nurse practitioner in charge who had been systematically trained but did not know the patient subgroup. The follow-up data was due on 2005-11-30.
Main observation indicators.
(i) Clinical outcomes of patients in both groups at admission, at discharge, and at 24 months of follow-up.
②Treatment and social function and family burden in both groups during the follow-up period.
Statistical analysis: SPSS 6.1 for windows software was used for statistical analysis, and the p-values were bilateral.
2. Results
2.1 Analysis of the number of participants: 76 patients completed the follow-up process as required.
2.2 Clinical outcomes of patients in both groups at admission, at discharge, and at 24 months of follow-up.
2.3 Social functioning and family burden
Several methods were used to evaluate social functioning in this study See Table 2. According to Table 1, the scores of the Experimental Group were significantly lower than those of the Control Group on the Overall Clinical Scale – Total Assessment of Efficacy Scale at 24 months of follow-up. According to Table 2, the total social functioning deficit was significantly lighter in the experimental group than in the control group throughout the follow-up period. All-day work time was an important index for evaluating social functioning, and the patients in the experimental group had significantly higher all-day work time after discharge than the control group.
3. DISCUSSION
Depression is a chronic recurrent disease with a high prevalence and suicide rate. Zhai Shutao reported that the prevalence of depression is 2G-3G. With the change of modern medical model, the treatment of depression has changed from the traditional medication-based treatment to a comprehensive treatment method combining medication and psychosocial interventions. It has been shown that appropriate social support not only has a direct role in helping the recovery from depression, but also is one of the important factors in the treatment of depression with social interventions to prevent relapse.
The etiology of depression is not clear, but genetic susceptibility has an important influence, and life events, especially emergency life events, play a role as a “boarder”, while social support and other factors are also involved. One study found that the average stress level of life events was significantly higher in the depressed group than in the normal control group, suggesting that there may be a direct relationship between life events and the development of depressive symptoms.
Depressed individuals tend to experience more life events, and social support is largely determined by individual behavior. Social support is the moral and material help and support given by individuals from all aspects of society, including family, society and self-help groups. Findings on the interactions between marriage and family in depressed individuals indicate that the social context of interpersonal loss and conflict is significantly higher in depressed individuals than in non-depressed individuals.Wade et al. also found that depression was associated with less social support and more interpersonal problems.
Some studies have confirmed that both negative events and social support are associated with the course of depression, but the mode of interaction is unclear. There are several approaches to treat depression, and the importance of individual differences needs to be taken into account as to which approach is best for the patient. It has been suggested that chronic stress and inadequate social support are important risk factors for the onset of depression in older adults and that early intervention should be provided to high-risk elderly populations, which could help prevent or reduce the onset of depression in older adults.