住院老年抑郁症患者服药依从性的影响因素分析-现代医学

住院老年抑郁症患者服药依从性的影响因素分析

单位：南京医科大学附属脑科医院老年精神科, 江苏南京 210000

分类号：R473

出版年·卷·期（页码）：2026·54·第一期（107-113）

摘要：

目的：探讨住院老年抑郁症患者服药依从性的现状及其影响因素，为临床实施针对性干预、改善治疗预后提供依据。方法：采用横断面设计，纳入本院320例住院老年抑郁症患者。收集人口学、生活方式、健康状况及心理指标，采用Morisky药物依从性量表-8(MMAS-8)评估服药依从性；多因素有序Logistic回归分析识别其独立影响因素。结果：患者服药依从性整体处于中等偏低水平，高、中、低依从性者分别占30.6%(98/320)、38.1%(122/320)和31.3%(100/320)。单因素分析显示，年龄、文化程度、已婚、独居、饮酒史、合并基础疾病、睡眠障碍、患者健康问卷抑郁量表(PHQ-9)评分、广泛性焦虑量表(GAD-7)评分、感知压力量表(PSS-10)评分和社会支持评定量表(SSRS)评分均与依从性显著相关(均P<0.05)。多因素有序Logistic回归分析显示，较高的文化程度(OR=2.86，95%CI：1.79~4.57)、已婚状态(OR=2.27，95%CI：1.48~3.49)和SSRS高评分(OR=1.21，95%CI：1.14~1.28)是服药依从性的独立保护因素；而年龄(OR=0.86，95%CI：0.81~0.91)、独居(OR=0.46，95%CI：0.29~0.72)、存在睡眠障碍(OR=0.41，95%CI：0.27~0.62)以及高的PHQ-9评分(OR=0.76，95%CI：0.70~0.82)、GAD-7评分(OR=0.79，95%CI：0.72~0.87)、PSS-10评分(OR=0.84，95%CI：0.79~0.89)是服药依从性的独立危险因素(均P<0.001)。基于此构建的预测模型判别力良好[曲线下面积(AUC)=0.84]。结论：住院老年抑郁症患者的服药依从性受社会人口学、健康及心理社会多维度因素的共同影响。临床干预应重点关注并整合婚姻与居住状态评估、睡眠障碍管理、情绪调节及社会支持体系强化，以制定个体化策略，从而有效提升服药依从性。

Objective: To investigate the current status and influencing factors of medication adherence in hospitalized elderly patients with depression, so as to provide evidence for clinical targeted interventions and improvement of treatment prognosis. Methods: A cross-sectional study was conducted, enrolling 320 hospitalized elderly patients with depression in our hospital. Sociodemographic characteristics, lifestyle, health status, and psychosocial indicators were collected. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale(MMAS-8). Multivariate ordinal logistic regression analysis was performed to identify independent influencing factors. Results: The overall medication adherence of the patients was at a moderate to low level, with 30.6%(98/320) having high adherence, 38.1%(122/320) having moderate adherence, and 31.3%(100/320) having low adherence. Univariate analysis showed that age, educational level, married living alone, drinking history, comorbid underlying diseases, sleep disorders, Patient Health Questionnaire-9(PHQ-9) score, Generalized Anxiety Disorder-7(GAD-7) score, Perceived Stress Scale-10(PSS-10) score, and Social Support Rating Scale(SSRS) score were all significantly correlated with medication adherence(all P<0.05). Multivariate ordinal Logistic regression analysis revealed that higher educational level(OR=2.86, 95%CI 1.79-4.57), married status(OR=2.27, 95%CI 1.48-3.49), and higher SSRS score(OR=1.21, 95%CI 1.14-1.28) were independent protective factors for medication adherence. In contrast, age(OR=0.86,95%CI 0.81-0.91) living alone(OR=0.46, 95%CI 0.29-0.72), presence of sleep disorders(OR=0.41, 95%CI 0.27-0.62), higher PHQ-9 score(OR=0.76, 95%CI 0.70-0.82), higher GAD-7 score(OR=0.79, 95%CI 0.72-0.87), and higher PSS-10 score(OR=0.84, 95%CI 0.79-0.89) were independent risk factors(all P<0.001). The constructed prediction model exhibited good discriminative ability(AUC=0.84). Conclusion: Medication adherence in hospitalized elderly patients with depression is jointly influenced by multidimensional factors including sociodemographic, health, and psychosocial factors. Clinical interventions should focus on and integrate assessment of marital and living status, sleep disorder management, emotional regulation, and social support system enhancement to formulate individualized strategies, thereby effectively improving medication adherence.

参考文献：

[1] 叶思聪,王晶.老年抑郁症伴认知功能损害影响因素的研究进展[J].海南医学,2025,36(7):1061-1064.
[2] 臧书兰,陆文,徐婷婷.基于PERMA模式的心理护理对老年抑郁症患者心理状态、自尊水平及生活质量的影响[J].心理月刊,2025,20(6):157-159.
[3] 伍晓婷,杨宜平.基于惩罚回归的老年抑郁症影响因素变量选择[J].许昌学院学报,2025,44(2):16-20.
[4] 王晶,吴彦,刘娜,等.老年抑郁症重度发作简易预测模型的构建及其预测价值[J].国际精神病学杂志,2025,52(1):148-152.
[5] 郭明英,韩国玲,阿怀红,等.心理护理对老年抑郁症患者康复的影响[J].青海医药杂志,2008,38(3):44-45.
[6] 张富松,符娟,潘苗.心理社会干预对老年抑郁症患者社会功能及生活质量的影响[J].职业与健康,2011,27(10):1124-1126.
[7] KWAN Y H,WENG S D,LOH D H F,et al.Measurement properties of existing patient-reported outcome measures on medication adherence:systematic review[J].J Med Internet Res,2020,22(10):e19179.
[8] FAHRNI M L,SAMAN K M,ALKHOSHAIBAN A S,et al.Patient-reported outcome measures to detect intentional,mixed,or unintentional non-adherence to medication:a systematic review[J].BMJ Open,2022,12(9):e057868.
[9] KROENKE K,SPITZER R L,WILLIAMS J B.The PHQ-9:validity of a brief depression severity measure[J].J Gen Intern Med,2001,16(9):606-613.
[10] SPITZER R L,KROENKE K,WILLIAMS J B W,et al.A brief measure for assessing generalized anxiety disorder:the GAD-7[J].Arch Intern Med,2006,166(10):1092-1097.
[11] COHEN S,KAMARCK T,MERMELSTEIN R.A global measure of perceived stress[J].J Health Soc Behav,1983,24(4):385-396.
[12] 肖水源.社会支持评定量表[J].中国心理卫生杂志(增刊)，1999:127-131.
[13] MORISKY D E,GREEN L W,LEVINE D M.Concurrent and predictive validity of a self-reported measure of medication adherence[J].Med Care,1986,24(1):67-74.
[14] DE OLIVEIRA-FILHO A D,MORISKY D E,NEVES S J F,et al.The 8-item Morisky Medication Adherence Scale:validation of a Brazilian-Portuguese version in hypertensive adults[J].Res Social Adm Pharm,2014,10(3):554-561.
[15] 陈黔,陈晓梅,钟萍,等.老年抑郁症患者药物治疗依从性的调查研究[J].实用心脑肺血管病杂志,2017,25(S2):206-207.
[16] 莫菁莲,陈翠,符锐,等.药学服务对老年首发抑郁症患者疗效影响和干预方式[J].临床合理用药杂志,2021,14(10):137-139.
[17] 王克,薛枫,郑军.心理社会因素对抑郁症患者药物治疗依从性的影响探讨[J].中国卫生标准管理,2015,6(18):22-23.
[18] 杨娜,胡忠义,高洋,等.环境暴露对老年抑郁症影响的研究进展[J].实用老年医学,2025,39(1):12-16,21.
[19] 许冬琴,严焕然,潘友让.老年抑郁症患者治疗依从性的影响因素[J].临床精神医学杂志,2024,34(4):310-313.
[20] 王存民.抑郁症患者药物治疗依从性影响因素及预防对策[J].中国处方药,2023,21(10):76-78.
[21] 涂艳,谢小云.抑郁症患者药物治疗依从性现状及其影响因素分析[J].中国医学创新,2023,20(1):107-111.
[22] 郑春美,蒋海潮,彭玲,等.抑郁症患者药物治疗态度和依从性的影响因素研究[J].浙江医学,2022,44(2):145-149.
[23] 余姿梵,苏家洁,薛将.老年抑郁患者医疗社会支持与生命质量的典型相关分析[J/OL].广东医科大学学报,2025,1-11.(2025-04-21).https://kns.cnki.net/kcms/detail/44.1731.r.20250418.1412.003.
[24] 徐露婷,周小丽,薛明月.社会支持、自我感知老化对老年慢性阻塞性肺病患者抑郁情绪的影响分析[J].实用预防医学,2024,31(1):94-96.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录