Page 52 - 2023-06-中国全科医学

2023年2月 第26卷 第6期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·693·

Clinic，Affiliated Hospital of Zunyi Medical University from December 2020 to February 2022，and equally randomized into a
sertraline group and an EMDR group. Sertraline group received a eight-week treatment with sertraline：the dose was 50 mg/d in
the first week and gradually increased to 100 mg/d in the second week，and could be increased to 200 mg/d at the end of the fourth
week if the patients had negative ideas or self-injurious behavior. The EMDR group received EMDR treatment，once a week，for
a total of 8 weeks. The Beck Depression Inventory （BDI），Beck Anxiety Inventory （BAI） and Connor-Davidson Resilience
Scale （CD-RISC） were used to evaluate the psychological status of the two groups before treatment，four weeks and eight
weeks after treatment. Results Except for five dropouts，the remaining cases who completed the trial were finally included，
including 28 in the sertraline group and 27 in the EMDR group. The treatment type and treatment duration had interactive effects
on the BDI，BAI and CD-RISC scores of the two groups（P<0.05）. The treatment duration had significant main effects on the
BDI，BAI and CD-RISC scores of the two groups（P<0.05）. The treatment type had significant main effects on BAI and CD-
RISC scores of the two groups （P<0.05），but produced no significant effects on the BDI scores （P>0.05）. EMDR group had
higher average CD-RISC score than sertraline group at four weeks after treatment（P<0.05）. EMDR group had higher average
CD-RISC score，and lower average BDI and BAI scores than sertraline group at eight weeks after treatment （P<0.05）. In the
sertraline group，the average BDI score at eight weeks after treatment was much lower than that at baseline or four weeks after
treatment （P<0.05），the BDI score after 4 weeks of sertraline treatment was lower than that before treatment（P<0.05），and
the average BAI score at eight weeks after treatment was much lower than that at basetime（P<0.05）. In the EMDR group，the
average BDI and BAI scores decreased significantly while the average CD-RISC score increased significantly at both four and eight
weeks after treatment compared with baseline levels （P<0.05）. And compared with four-week treatment，eight-week treatment
lowered the average BDI and BAI scores more significantly，and increased the average CD-RISC score more significantly
（P<0.05）. Conclusion Sertraline could partially improve depression and anxiety in depressed adolescents with childhood
trauma，but had no significant improvement of psychological elasticity. In contrast，EMDR could effectively improve the
depression and anxiety as well as psychological elasticity，so it could be used as the preferred treatment.
【Key words】 Depressive disorder；Posttraumatic growth，psychological；Eye movement desensitization and
reprocessing；Sertraline；Adolescent；Anxiety；Comparative effectiveness research

中国抑郁障碍的 12 月患病率为 3.6%，终身患病率 治疗方法，构建了适应性信息加工模型的理论基础，通
为 6.8% ［1］ 。抑郁症是心理、社会和遗传等多因素共同 过眼动、脱敏和再加工，以帮助恢复大脑信息加工系统
作用的结果，其中童年创伤被认为是抑郁症发生发展中 的平衡，其治疗目标不局限于帮助患者缓解创伤和焦虑，
最为常见且尤为重要的心理社会因素 ［2-3］ 。童年创伤被 还包括引出正向情绪、唤起自觉、改变信念和行为 ［10］ 。
定义为早期生活中重要的、有压力的负面经历，如性虐 EMDR 在治疗创伤有关的心理疾病中发挥了其独特的优
待、躯体虐待、躯体忽视、情感虐待和情感忽视等 ［4］ 。 势，近年来也逐渐用于抑郁症的治疗，并取得了一定的
据世界卫生组织（WHO）调查显示：超过三分之一的 效果 ［11-13］ ，但国内的相关研究较少。故本研究通过对
人口曾经历过童年创伤，其对身心健康的影响贯穿整个 EMDR 和舍曲林治疗伴童年创伤的青少年抑郁症患儿的
生命过程 ［4］ 。伴童年创伤抑郁症患者具有其独特的临 效果差异进行分析，以探索更优的临床治疗方案，为提
床特点：抑郁表现往往更重，自杀风险更高，认知受损 升伴童年创伤的青少年抑郁症治疗效果提供帮助，并为
程度更重，危害程度更大，对抗抑郁药物的治疗应答也 进一步研究 EMDR 的临床应用提供科学数据。
更差 ［5］ 。 1 对象与方法
儿童青少年抑郁症的治疗方法主要包括心理治疗、 1.1 研究对象 选取 2020 年 12 月至 2022 年 2 月就诊
药物治疗和物理治疗等 ［6］ 。部分学者证实了舍曲林治 于遵义医科大学附属医院心理门诊的符合国际疾病分
疗儿童青少年抑郁症是安全有效的 ［7-8］ 。但 2004 年美 类 第 10 版（International Classification of Diseases-10，
国食品药品监督管理局指出抗抑郁药物可能会增加儿 ICD-10）轻中度抑郁症诊断标准，且童年创伤问卷简
童青少年自杀观念和行为的危险性，同时舍曲林等抗 版（Childhood Trauma Questionnaire-short Form，CTQ-
抑郁药物可能存在头晕、嗜睡、恶心及腹痛等不良反 SF） ［14］ 筛查阳性的 60 例患儿为研究对象。
应 ［9］ ，因此青少年抑郁症的首选治疗常为心理治疗 ［6］ 。 1.1.1 纳入标准 （1）经由 2 名从事精神卫生行业超
眼 动 脱 敏 与 再 加 工（eye movement desensitization and 过 10 年的精神科主治医师及以上职称的医师对患者病
reprocessing，EMDR）作为一种整合了生理学、催眠学、 情进行评估，一致认为符合 ICD-10 轻中度抑郁症诊断
心理动力学、行为学和认知行为学等多学科观点的心理 标准；（2）CTQ-SF 结果至少 1 项因子为阳性；（3）