Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders
Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders
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DOI：
10.1093/fampra/19.2.161
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发表时间：
2002-04-01
期刊：
影响因子：
2.2
通讯作者：
Shvartzman, P
中科院分区：
文献类型：
--
作者：
Gidron, Y;Duncan, E;Shvartzman, P
背景资料。心理社会变量，如重大应激生活事件/日常应激事件，与卫生保健利用有关。我们的目的是检验过去创伤的指导性披露协议(GDP)对经常就诊的患者的症状和临床就诊的影响。41名经常去诊所就诊的人(每3个月就诊2次以上)参加了研究。患者被随机分配到随机内容写作对照组(n=19)或创伤内容写作实验GDP组(n=22)。GDP患者按时间顺序写下一个令人心烦的事件(第一天)，口头描述他们的想法和感受，描述事件对生活的影响(第二天)，最后写下他们现在对事件的看法和未来的应对方式(第三天)。3个月后，对患者的症状和就诊情况进行盲法评估，平均15个月后，再次对患者进行盲法就诊评估。与对照组相比，GDP患者在3个月时报告的症状水平较低(2.3对5.2)，在3个月(1.3对3.0)和15个月(5.1对9.7)的随访期间就诊次数较少。在15个月的随访中，GDP患者就诊次数大于或等于10次的比例(10%)低于对照组(33%)。这些发现将之前的发现扩展到经常使用临床的人，使用了一种新的书面披露形式，旨在将创伤从内隐记忆转移到外显记忆。GDP可能是初级保健中一种廉价的额外干预措施，可以减少经常使用诊所的患者的症状和就诊次数。
Background. Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization.Objective. Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders.Methods. Forty-one frequent clinic allenders (greater than or equal to2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and descibed the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again.Results. Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making greater than or equal to10 visits during the 15 month follow-up was smaller (10%) than among controls (33%).Conclusions. The findings extend previous findings to frequent clinic users, using anew form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.