Effects Of Motivational Interviewing And Transtheoretical Model Intervention For Depression In Hospitalized Patients With COPD

Objectives To investigate the anxiety and depression in patients with Chronic Pulmonary Disease(COPD) who were hospitalized for acute exacerbations;to explore the factors related to depression in hospitalized patients with COPD;to determine the effects of Motivational Interviewing(MI) and Transtheoretical Model Intervention(TTMI) on anxiety and depression;to determine the effects of MI and TTM Intervention on coping style,quality of life(QOL),self-efficacy,Index well-being(IWB),degree of pulse oximetry,Mood Management TTM Stages,Pulmonary Rehabilitation(PR) and Mood Management Motivations,confidence on disease and mood improvement and Mood Management Decisional Balance(MMDB);to further prove the effects of MI and TTM intervention on cognitive behavioral of patients with COPD from patient's trying frequency of Mood Management(MM),trying amounts of Mood Management Resources(MMR),Mood Management Practice Measures(MMPM),Mood Management objectives and evaluations to interventions after interventions and phone follow-ups.Methods This study was an Quasi-experimental survey.132 patients with COPD who were hospitalized for acute exacerbations in Xiang-Ya hospital,the Second and the Third Xiang-Ya hospital of Central South University,the first and the third Changsha hospital were selected to be samples.To avoid contamination effects,82 in the control group were collected from August to December in 2008,50 in the experimental group were collected from from January to April in 2009;Subjects in the experimental group were given two weeks' psychological intervention which including 20 minutes' MI and 20 minutes' TTMI two times separately in addition to routine care in hospital,and 15 minutes' phone follow-up per week ongoing two weeks after discharging from hospitals; while those in the control group were given routine care only.The outcome of anxiety,depression,coping style,quality of life(QOL), self-efficacy,IWB,degree of pulse oximetry Mood Management TTM Stages,PR and Mood Management Motivations,confidence on disease and mood improvement were evaluated between pre and post intervention to analyze the effects of MI and TTMI.The outcome of depression,Mood Management TTM Stages,PR and Mood Management Motivations, confidence on disease and mood improvement,Mood Management Decisional Balance(MMDB) were reassessed in the experimental group after follow-ups to testify the effects of interventions on emotional handicap cognitive behavioral changes of patients with COPD.Results 1.The baseline results showed that the average score of HAD-A was 7.84±4.14(0～21),the patients with anxiety a accounted for 48%(57 cases);the average score of HAD-D was8.80±4.73(0～19),the patients with depression screened by HAD-D accounted for 66%(78 cases);the average score of Center for Epidemiologic Studies Depression Scale(CES-D) was 28.25±11.03(6～49),the patients with depression accounted for 78.2%(93 cases);Multiple linear regressions indicated that Depression experiences,Self-rated general health and Family APGAR Index(APGAR) were the independent influential factors of anxiety and depression.2.The levels of anxiety(HAD-A),depression(HAD-D,CES-D) were significant in experimental group between pre and post interventions(P＜0.05),the level of depression(measured by HAD-D) was not significant in the control group(P＞0.05),the level of anxiety and depression(measured by HAD-D) were alleviated in control group. The difference of depression(HAD-D,CES-D) and anxiety(HAD-A) between experimental and control groups were significant after interventions(P＜0.05),the levels of anxiety and depression of experimental group were lower than control group.Chi-square Test showed that the positive rate of depression after interventions significantly lower than control group after interventions(P＜0.05).3.The scores of Confrontation and Avoidance of Medical Coping Modes Questionnaire(MCMQ) in the experimental group after interventions were significantly higher than before(P＜0.05),The scores of Resignation of MCMQ in experimental group after interventions were significantly lower than before(P=0.001).The scores of Confrontation in control group were higher than before(P＜0.05),while there were no significant difference in Avoidance and Resignation (P＞0.05).The differences of scores of Confrontation,Avoidance and Resignation between the experimental and the control groups were significant pre and post interventions(P＜0.05),The scores of Confrontation and Avoidance in intervention group after interventions were increased significantly,the scores of Resignation decreased significantly,and both changed more than control group.4.The scores of Dyspnea of Chronic Respiratory Questionnaire(CRQ) in control group were significant between pre and post interventions (P=0.013),while there were no significance in scores of Emotion,Fatigue and Mastery between pre and post interventions(P＞0.05);The scores of all scales of CRQ were increased in experimental group after interventions,while there is no difference in Dyspnea between the two groups.5.Tere were no significance of the scores of self-efficacy,IWB,PR and Mood Management Motivations,confidence on mood and disease improvement in the control group between pre and post interventions (P＞0.05),there was also no significance of the number of people in Mood Management stages pre and post interventions,while the scores of degree of pulse oximetry,Mood Management Motivation and confidence on disease improvement were increased significantly(P＜0.05) As to Mood Management stages of those who in the experimental group,The number of subjects decreased in the Precontemplation Stage and increased in the Contemplation,the Preparation and the Action Stage,the result is significant(P＜0.05);The scores of self-efficacy,IWB,Mood Management Motivations confidence on mood and disease improvement except PR Motivation were significant pre and post interventions(P＜0.05) in the experimental group and scores of all indicators changed more than control group except confidence on disease improvement(p=0.114).6.Repeated measures analysis of variance showed that the main effects of intervention on anxiety,depression,coping style,quality of life(QOL),self-efficacy,IWB,Mood Management Motivations and confidence on mood improvement were significant(P＜0.01),in other word,scores of anxiety,depression,coping style,quality of life(QOL), self-efficacy,IWB,Mood Management Motivations and confidence on mood improvement were significantly between different interventions without taking account the changing of time.There were significant interactions(P＜0.01) between time and intervention except Conference Avoidance(P=0.057) and Dyspnea(P=0.551).The main effects of time in both groups on domains of anxiety,depression,coping style,Resignation, Emotion,Fatigue,Mastery,self-efficacy,IWB,Mood Management Motivations and confidence on mood improvement were significant pre and post interventions(P＜0.05).Interaction diagram indicated that the improvement degree of anxiety,depression and Resignation were lower in experimental group than that of control group,but the score of Emotion,Fatigue,Mastery,subjective well-being,the self-efficacy,Mood Management Motivations and confidence on mood improvement in experimental group were higher than the control group.7.Wilcoxon signed ranks test showed that the degree and symptoms of depression,Mood Management and PR Motivation,confidence on disease and mood improvement,TTM Decisional Balance and Mood Management TTM Stages were significant between pre and post follow-up interventions.The number of people was increased in Contemplation Stage,Preparation Stage and Action Stage,the self-perceived Roadblocks score of Mood Management Decisional Balance(MMDB) decreased and the self-perceived Benefits score as well as the scores of other indicators increased.The McNemar Test showed that the positive rate of depression after follow-up interventions significantly lower than before follow-ups(P＜0.05).8.The trying frequency of Mood Management(MM),using amounts of Mood Management Resources(MMR),Mood Management Practice Measures(MMPM) in experimental group after follow-up interventions were significantly higher than before follow-ups(P＜0.05).The number of people in experimental group chose "no clear objective" and "keeping the present situations" decreased and those who chose "taking chances to try" and "striving to implement" of Mood management objectives increased after follow-ups.As to evaluation of our interventions,those who in experimental group chose "a little help" decreased,chose" moderate help","a lot help" and "significant help" increased and difference between pre and post follow-ups were significant(P＜0.05).Conclusion 1.Depression experiences,Self-rated general health and Family APGAR Index(APGAR) were significantly related to anxiety and depression of hospitalized patients with COPD.2.MI and TTMI could decrease the levels of anxiety and depression of hospitalized patients with COPD.3.MI and TTMI can improve coping style,Emotion,Fatigue and Mastery of Chronic Respiratory Questionnaire(CRQ),self-efficacy,IWB, Mood Management and PR Motivation,confidence on mood improvement of hospitalized patients with COPD;The interventions can increase the Self-perceived Benefits and decrease the Self-perceived Roadblocks of TTM Decisional Balance.5.MI and TTMI have positive effects on emotional handicap and cognitive behavioral change of patients with COPD.