Effect Of Yi Shu Psychodrama Combined With Drug Therapy On Hpaaxis Activity And Coping Style In Patients With Childhood Traumatic Depression

Objectives:1.To understand the proportion of childhood trauma in psychiatric outpatients and inpatients with depression and the distribution of childhood trauma subtypes.2.To explore the characteristics of HPA axis activity and coping style in patients with childhood traumatic depression.3.To explore the influence of Yi Shu psychodrama combined with drug therapy on the HPA axis activity of saliva and coping style in patients with childhood traumatic depression,and provide scientific basis for research of its neuroendocrine mechanism and clinical application.Methods:1.The Childhood Trauma Questionnaire(CTQ)was used to assess the traumatic condition of 406 cases in psychiatric outpatients and inpatients with depression during their childhood.2.According to the CTQ scale results,48 patients were randomlyenrolled in the group with childhood traumatic depression,49 patients were enrolled in the group without childhood traumatic depression,and 51 people were enrolled in the health control group with childhood trauma.The Beck Depression Inventory-13 item(BDI-13),Beck Anxiety Inventory-21 item(BAI-21),and Trait Coping Style Questionnaire(TCSQ)were used to assess the characteristics of depressive,anxious severity and coping style.Saliva was collected from three groups during the morning waking and half an hour after waking,and the concentration of salivary cortisol was determined by enzyme-linked immunosorbent assay(ELISA).3.The group with childhood traumatic depression was randomly divided into the experimental group(Yi Shu psychodrama combined with antidepressants group)and the control group(mental health education combined with antidepressants group).The intervention was conducted in batches for 3 times,2 months between each time,4 days for a time,a total of 12 days,and a duration of half a year.Before and after the intervention,the Beck Depression Inventory(BDI-13),the Beck Anxiety Inventory(BAI-21),the Hamilton Depression Rating Scale-17 item(HAMD-17),and the Trait Coping Style Questionnaire(TCSQ)were used to assess the the characteristics of the patients.Saliva was collected from two groups during the morning waking and half an hour after waking,and the concentration of salivary cortisol was determined by enzyme-linked immunosorbent assay(ELISA).Finally,statistical analysis was performed using SPSS 17.0 statistical software.Results:1.Among the 406 adult depression patients investigated in this study,256(63.1%)patients with childhood traumatic depression were found.Each type of trauma included: 74(18.2%)existed childhood emotional abuse;43(10.6%)existed physical abuse;57(14.0%)existed sexual abuse;166(40.9%)existed emotional neglect and 161(39.7%)existed physical neglect.Among them,there were 104 people(25.6%)with one type of childhood trauma,85(20.9%)with two types of childhood trauma,and 67(16.5%)with three or more types of childhood trauma.2.The positive coping style,negative coping style and HPA axis activity were compared among the three groups with childhood traumatic depression group,without childhood traumatic depression group and with childhood traumatic healthy control group,and the differences were statistically significant(P<0.01).3.The differences were not statistically significant in depression and anxiety between the two groups with and without childhood traumatic depression(P>0.05),and the differences were statistically significant in the positive coping style,negative coping style and HPA axis activity(P<0.05).Compared the childhood traumatic depression group and the non-child traumatic depression group with the childhood traumatic healthy controlgroup in the positive coping style,negative coping style and HPA axis activity,the differences were statistically significant(P<0.05).4.The differences were statistically significant in depression,anxiety,positive coping style,negative coping style and HPA axis activity before and after intervention in the experimental group(P<0.05).5.The differences were statistically significant in depression,anxiety and HPA axis activity before and after intervention in the control group(P<0.05),but the differences were not statistically significant in positive coping style and negative coping style(P>0.05).6.Compared the changes of BDI,HAMD,positive coping style and negative coping style before and after intervention between the experimental group and the control group,the differences were statistically significant(P<0.05),and compared the changes of BAI and HPA axis activity,the differences were not statistically significant(P>0.05).Conclusions:1.This study found that childhood trauma had a high incidence in psychiatric outpatients and inpatients with depression.The incidence of emotional neglect was highest in all types of childhood trauma,followed by physical neglect.The lowest incidence was physical abuse.The incidence of multiple trauma coexistence was higher than a type trauma.2.HPA axis functional activity level is higher with childhood traumatic depression than without childhood traumatic depression.Indealing with life events,it is more inclined to adopt a negative coping style and less active coping style.3.Yi Shu psychodrama combined with antidepressant therapy and mental health education combined with antidepressant therapy can both change the anxiety and HPA axis activity in patients with childhood traumatic depression,and the former improves depression and coping styles better.This study suggests that Yi Shu psychodrama combined with antidepressant therapy is a treatment that can be effectively applied to clinical depression intervention,but the biological mechanism of its effect needs further exploration.