Ciechanowski Paul, Wagner Edward, Schmaling Karen, Schwartz Sheryl, Williams Barbara, Diehr Paula, Kulzer Jayne, Gray Shelly, Collier Cheza, LoGerfo James
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195-6560, USA.
JAMA. 2004 Apr 7;291(13):1569-77. doi: 10.1001/jama.291.13.1569.
Older adults with social isolation, medical comorbidity, and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with older adults without these characteristics.
To determine the effectiveness of a home-based program of detecting and managing minor depression or dysthymia among older adults.
Randomized controlled trial with recruitment through community senior service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003.
One hundred thirty-eight patients aged 60 years or older with minor depression (51.4%) or dysthymia (48.6%). Patients had a mean of 4.6 (SD, 2.1) chronic medical conditions; 42% of the sample belonged to a racial/ethnic minority, 72% lived alone, 58% had an annual income of less than 10 000 dollars, and 69% received a form of home assistance.
Patients were randomly assigned to the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) intervention (n = 72) or usual care (n = 66). The PEARLS intervention consisted of problem-solving treatment, social and physical activation, and potential recommendations to patients' physicians regarding antidepressant medications.
Assessments of depression and quality of life at 12 months compared with baseline.
At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to have at least a 50% reduction in depressive symptoms (43% vs 15%; odds ratio [OR], 5.21; 95% confidence interval [CI], 2.01-13.49), to achieve complete remission from depression (36% vs 12%; OR, 4.96; 95% CI, 1.79-13.72), and to have greater health-related quality-of-life improvements in functional well-being (P =.001) and emotional well-being (P =.048).
The PEARLS program, a community-integrated, home-based treatment for depression, significantly reduced depressive symptoms and improved health status in chronically medically ill older adults with minor depression and dysthymia.
与没有这些特征的老年人相比，存在社会隔离、合并内科疾病和身体功能障碍的老年人更易患抑郁症，但可能较难寻求到针对抑郁症的适当治疗。
确定一项针对老年人的家庭式轻度抑郁症或心境恶劣障碍检测与管理项目的有效性。
2000年1月至2003年5月在华盛顿州西雅图市通过社区老年服务机构进行招募的随机对照试验。
138例年龄在60岁及以上的患有轻度抑郁症（51.4%）或心境恶劣障碍（48.6%）的患者。患者平均患有4.6种（标准差2.1种）慢性内科疾病；样本中42%属于少数种族/族裔，72%独自生活，58%年收入低于10000美元，69%接受某种形式的居家援助。
患者被随机分配至鼓励老年人积极、有益生活项目（PEARLS）干预组（n = 72）或常规治疗组（n = 66）。PEARLS干预包括解决问题疗法、社交和身体活动，以及就抗抑郁药物向患者的医生提出潜在建议。
与基线相比，在12个月时评估抑郁情况和生活质量。
在12个月时，与常规治疗组相比，接受PEARLS干预的患者更有可能出现抑郁症状至少减轻50%（43%对15%；优势比[OR]，5.21；95%置信区间[CI]，2.01 - 13.49），实现抑郁症完全缓解（36%对12%；OR，4.96；95%CI，1.79 - 13.72），并且在功能健康（P = 0.001）和情绪健康（P = 0.048）方面与健康相关的生活质量改善更大。
PEARLS项目是一项针对抑郁症的社区综合居家治疗，可显著减轻患有轻度抑郁症和心境恶劣障碍的慢性内科疾病老年患者的抑郁症状并改善其健康状况。
