| Objectives To investigate the depression in hospitalized patients with coronary heart disease (CHD); to explore the factors related to depression in hospitalized patients with CHD; to introduce and formalize the Pro-Change manual and meatures; to determine the effects of Transtheoretical Model Intervention (TTMI) and Motivational Interviewing (MI) on depression; to evaluate the effects of TTMI and MI on quality of life and depression management (the Stage of Chang,the Process of Chang,Decisional Balance,Self-efficacy); to evaluate the long-term impacts of intervention after phone follow-ups.Methods This was an experimental study. After the revise of the manual and meatures,110 hospitalized patients with CHD in Xiang-Ya hospital, the Second and the Third Xiang-Ya hospital of Central South University were selected to be samples. They were randomly divided into two groups,55 in the control group and 55 in the intervention group. Subjects in the intervention group were given the manual and received psychological intervention which including 20 minutes'TTMI three times and 20 minutes'MI two times separately in addition to routine care in hospital, and 15 minutes'phone follow-up every two weeks ongoing three month were given to the intervention group after they were discharged from the hospital to reinforce the intervention; while those in the control group were given routine care only. The outcome of depression, quality of life, depression management were evaluated between pre and post intervention to analyze the effects of TTMI and MI. The same outcomes were reassessed at 1 month and 3 month after being discharged in intervention group to testify the long-term impacts of intervention.Results 1. The baseline results showed that the average score of depression was 24.40±5.99, the patients with depression accounted for 58.3%, including 54.4%patients of mild or moderate level depression, 3.9%patients of severe level depression of the total 103 participants; Multiple linear regression indicated that Sex, Age, Coronary angiograph and Family APGAR Index were the independent influential factors of depression.2. Analysis of data after intervention(1) DepressionRepeated measures analysis of variance showed that main intervention effect on depression was not significant (P>0.05), in other word, depression was not significantly different between different interventions without taking account the change of time; the main time effect on depression was significant(P<0.05); there was significant interaction between time and intervention, and interaction diagram indicated that the decrease degree of depression was higher in intervention group than that of control group over time after intervention.Compared the level of depression pre and post intervention in both intervention and control group, the level of depression were lower after intervention than before in both two groups (P<0.05).Analysis of Covariance shows that the difference of depression between intervention and control groups was significant after intervention(P<0.05), the level of depression of intervention group was lower than control group. Chi-square Test showed that the positive rate of depression after intervention significantly lower than the control group(P<0.05).(2) Quality of lifeRepeated measures analysis of variance showed that main intervention effect on the disease perception was significant (P<0.05),but not significant on the other four dimensions(P>0.05); the main time effects on all the five dimensions of SAQ were significant (P<0.05), and there were significant interactions between time and intervention on the the physical limitation, the anginal stability and the disease perception(P<0.05), but not on the anginal frequency and the treatment satisfaction(P>0.05).Compared the five dimension of SAQ pre and post intervention in both intervention and control group, the scores of the five dimension were higher after intervention than before in both two groups (P<0.05).Analysis of Covariance shows that the difference of the anginal stability between intervention and control groups was significant after intervention(P<0.05), but not of the other dimension of SAQ(P>0.05),the score of the anginal stability of intervention group was higher than control group.(3) Depression management processWilconox sign-rank test results showed that the stages of change moved forward pre and post intervention in the intervention group(P<0.05), while there were not difference in the stages of the change pre and post intervention in the control group(P>0.05).Repeated measures analysis of variance showed that main intervention effects on the Decisional Balance, Process of Change and Self-efficacy were significant (P<0.05), in other words, scores of the Decisional Balance, Process of Change and Self-efficacy were significantly different between different interventions without taking account the change of time; the main time effects on all the indicators above were significant (P<0.05), and there were significant interactions between time and intervention (P<0.05) except the Cons; the increase degree of Pros, Cognitive Processes, Behavioral Processes and Self-efficacy were higher in intervention group than that of control group over time after intervention.Compared the scores of Decisional Balance, Process of Change and Self-efficacy pre and post intervention in both intervention and control group, the scores of Cons was lower after intervention than before in intervention groups (P<0.05),while the scores of other indicators were higher than before(P<0.05). Only the scores of Cognitive Processes and Self-efficacy were higher after intervention than before in control group(P<0.05), while the scores of other indicators were not significantly different than before(P>0.05).Analysis of Covariance showed that the difference of Decisional Balance, Process of Change and Self-efficacy between intervention and control groups were significant after intervention(P<0.05), the scores of Pros, Cognitive Processes, Behavioral Processes and Self-efficacy of intervention group were higher than control group;the score of Cons of intervention group was lower than that of control group. 3. Analysis of data after phone follow-ups(1) Compared the level of depression for the patients in intervention group at T, T0, T1 and T3, the levels of depression were significantly different between those at T and T0, T and T1, T and T3 but not at any two comparison among T0, T1 and T3.(2) Compared the scores of SAQ for the patients in intervention group at T, To, T1 and T3,③the scores of the physical limitation were significantly different between those at T and T0,Tand T1, T and T3,but not at any two comparison among T0, T1and T3.②the scores of the anginal stability were significantly different between those at any two comparison among T,T0, T1 and T3 except at T1 and T3.③the scores of the anginal frequence were not significantly different among T,T0, T1 and T3.④the scores of the treatment satisfaction were significantly different between those at T and T0,T and T1, T and T3, but not at any two comparison among T0, T1 and T3.⑤the scores of the disease perception were significantly different between those at any two comparison among T,T0, T1 and T3 except at T1 and T3.(3) Compared the stages of change for the patients in intervention group at T, T0, T1 and T3, the the number of people at each stages of change were significantly different among T,T0,T1 and T3; the stages of change moved forward over time.(4) Compared the scores of Decisional Balance, Process of Change and Self-efficacy for the patients in intervention group at T, T0, T1 and T3,①the scores of Pros increased over time, the differences were significant between those at T and T0,T and T1, T and T3,T0 and T3.②the scores of Cons were significantly different between those at T0 and T, T0 and T1 and T0and T3. but not between those at T and T1, T and T3,T1 and T3.③the scores of the Cognitive Processes and Behavioral Processes incressed over time; the differences were significant between any two comparison among T,T0, T1 and T3.④the scores of Self-efficacy increased over time; the differences were significant between any two comparison except between T1 and T3.Conclusion 1.The positive rate of depression in hospitalized patients with CHD is high, and sex, age, coronary angiograph and family APGAR are significantly related to the level of depression.2. TTMI and MI can decrease the level of depression of hospitalized patients with CHD.3. TTMI and MI can improve most aspects of quality of life of hospitalized patients with CHD.4. TTMI and MI can lead the depression management stages of change to move forward; can improve the Pros and reduce the Cons; increase the Cognitive Processes and Behavioral Processes; also can improve the Self-efficacy of hospitalized patients with CHD.5. Phone follow-ups can maintain the long-term effects of intervention. |
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