Journal of Mazandaran University of Medical Sciences
مجله دانشگاه علوم پزشکی مازندران
J Mazandaran Univ Med Sci
Medical Sciences
http://jmums.mazums.ac.ir
1
admin
1735-9260
1735-9279
fa
jalali
1401
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2023
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اثربخشی شناخت درمانی مبتنی بر ذهن آگاهی روی امید به زندگی، هراس از مرگ و تنظیم قند خون بیماران دیابتی مبتلا به افسردگی
Effectiveness of Mindfulness-Based Cognitive Therapy on Life Expectancy, Fear of Death and Glycemic Control in Diabetic Patients with Depression
روانشناسی
psychology
پژوهشي-کامل
Research(Original)
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:95%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="FA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">افسردگی</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">یکی</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">از</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">شایع</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">ترین</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">اختلالات</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">روانپزشکی</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">در</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بیماران</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">دیابتی</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">است،</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">که</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">علاوه</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بر</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">اثر</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">در</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">سیر درمان، می</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">تواند</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">پیش</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">آگهی</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بیماری</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">را</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">نیز</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">تغییر دهد</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">. مطالعه حاضر با هدف بررسی اثربخشی شناختدرمانی مبتنی بر ذهنآگاهی روی امید به زندگی، هراس از مرگ و تنظیم قند خون بیماران دیابتی مبتلا به افسردگی انجام شد.</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:#0e101a"></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:95%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.1pt"></span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.1pt">این پژوهش نیمهآزمایشی با طرح پیشآزمون و پسآزمون و گروه کنترل، با جامعه آماری 867 </span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.1pt">بیمار،</span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"> انجام شد.</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">معیارهای ورود شامل ابتلا به دیابت نوع 2، سن 65-20 سال، حداقل تحصیلات سیکل و هموگلوبین گلیکوزیله (</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">HbA1c</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">) کم</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">تر از 7 درصد بود. برای انتخاب نمونه،</span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">پرسشنامه افسردگی بک</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"> تکمیل و </span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">30 </span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بیمار مبتلا به </span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">افسردگی متوسط تا شدید، بهطور تصادفی در دو گروه 15نفری قرار گرفته و وارد مطالعه شدند.</span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">ابزار مورد استفاده، </span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">پرسشنامه آزمون امید به زندگی میلر و هراس از مرگ تمپلر(1970) و پرسشنامه افسردگی بک(2000) و تعیین</span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%">HbA1c</span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بود. مداخله شناخت درمانی مبتنی بر ذهنآگاهی طی 8 جلسه و هر جلسه 90 دقیقه انجام پذیرفت. گروه کنترل هیچ آموزشی دریافت نکردند. فرضیهها با تحلیل کوواریانس آزموده شدند.</span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:95%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">تاثیر شناخت درمانی مبتنی بر ذهنآگاهی در </span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بیماران دیابتی مبتلا به افسردگی</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"> به ترتیب برای </span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">متغیر امید به زندگی (0/000=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">P</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">، 25/21=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">F</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">)</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">،</span></span></span> <span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">هراس از مرگ(0/000=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">P</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">، 157/77=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">F</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">) و</span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%">HbA1c</span></span><span style="line-height:95%"><span style="font-family:"B Zar""> <span lang="AR-SA" style="color:black">(0/000=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">P</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">، 151/61=</span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="color:black">F</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">)</span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">بود</span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">.</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:95%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman","serif""><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Koodak""><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.2pt">شناخت درمانی مبتنی بر ذهن آگاهی روی امید به زندگی، هراس از مرگ و</span></span></span></span> <span dir="LTR" style="font-size:10.0pt"><span style="line-height:95%"><span style="letter-spacing:-.2pt">HbA1c</span></span></span> <span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.2pt">بیماران دیابتی افسرده تاثیر</span></span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"> مثبت دارد. بر این اساس، پیگیری و درمان آن</span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"Cambria","serif""><span style="color:black"></span></span></span><span lang="FA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black">ها به شیوه غیردارویی با روش شناختدرمانی مبتنی بر ذهنآگاهی در درجه <span style="letter-spacing:-.1pt">اول و در صورت نیاز مداخله دارویی کمک شایانی به جهت کنترل قندخون، کاهش شدت و سیر عوارض مزمن خواهد کرد.</span></span></span></span><span lang="AR-SA" style="line-height:95%"><span style="font-family:"B Zar""><span style="color:black"><span style="letter-spacing:-.1pt"></span></span></span></span></span></span></span></span></span></span></span>
<span style="font-size:12pt"><span style="line-height:150%"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif""><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">Depression is one of the most common psychiatric disorders in diabetic patients that could change the disease prognosis in addition to affecting the treatment path. The aim of this study was to evaluate the effectiveness of mindfulness-based cognitive therapy (MBCT) on life expectancy, fear of death, and glycemic control in diabetic patients </span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:150%">suffering from depression.</span></span><span style="font-size:10.0pt"><span style="line-height:150%"></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="text-autospace:none"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif"">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">A quasi-experimental research with pre-test/post-test design and control group was conducted. The statistical population included 867 patients. The study inclusion criteria were type 2 diabetes, 20-65 years of age, secondary school education, and HbA1c below 7. </span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:150%">Beck Depression Inventory-II (BDI-II) was completed and patients with moderate to severe depression</span></span><span style="font-size:10.0pt"><span style="line-height:150%"> were selected (n= 30). They were randomly assigned into two groups. </span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:150%">Data were collected using</span></span><span style="font-size:10.0pt"><span style="line-height:150%"> Miller Hope Scale, Templer Death Anxiety Scale (1970), BDI</span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:150%">-II</span></span><span style="font-size:10.0pt"><span style="line-height:150%">, and measurement of HbA1c level. MBCT was performed for eight weekly sessions of 90 minutes, while the control group received no specific training. Data analysis was carried out applying Analysis of covariance (ANCOVA).</span></span><span style="font-size:10.0pt"><span style="line-height:150%"></span></span></span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:150%"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif"">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">Findings showed significant improvements in life expectancy (P= 0.000, F= 25.21), death anxiety (P= 0.000, F= 157.77), and HbA1c level (P= 0.000, F= 151.61) after the intervention.</span></span><span lang="EN" style="font-size:10.0pt"><span style="line-height:150%"></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:150%"><span style="vertical-align:top"><span style="font-family:"Times New Roman","serif""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span style="font-family:"Arial","sans-serif"">Conclusion:</span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">MBCT is effective in improving life expectancy, fear of death, and HbA1c level in diabetic patients with depression. Therefore, attention should be paid to diagnose depressive disorders in diabetic patients and their follow-up and non-pharmacological treatments such as MBCT which could be of great benefit in controlling blood sugar level and reducing the severity of chronic complications.</span></span><i><span style="font-size:10.0pt"><span style="line-height:150%"></span></span></i></span></span></span></span>
شناخت درمانی, ذهن آگاهی, امید به زندگی, هراس از مرگ, قندخون, دیابت, افسردگی
cognitive therapy, mindfulness, life expectancy, fear, glycemic control, diabetes, depression
105
114
http://jmums.mazums.ac.ir/browse.php?a_code=A-10-183-8&slc_lang=fa&sid=1
Sara
Gholamnejad
سارا
غلام نژاد
sara.gholami05@gmail.com
1003194753284600150808
1003194753284600150808
No
MSc in Clinical Psychology, Faculty of Medical Sciences, Islamic Azad University, Sari Branch, Iran
کارشناسی ارشد، روانشناسی بالینی، دانشکده ی علوم پزشکی، دانشگاه آزاد اسلامی واحد ساری، ایران
Adele
Bahar
عادله
بهار
doctor_bahar2000@yahoo.com
1003194753284600150809
1003194753284600150809
Yes
Professor, Department of Internal Medicine, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
استاد، گروه داخلی، مرکز تحقیقات دیابت، دانشگاه علوم پزشکی مازندران، ساری، ایران
Mohsen
Fazl Ali
محسن
فضل علی
Mohsen.Fazlali@yahoo.com
1003194753284600150810
1003194753284600150810
No
Psychiatrist, Faculty of Medical Sciences, Islamic Azad University, Sari Branch, Iran
متخصص روان پزشکی، دانشکده ی علوم پزشکی، دانشگاه آزاد اسلامی واحد ساری، ایران