Roy-Byrne Peter, Sherbourne Cathy, Miranda Jeanne, Stein Murray, Craske Michelle, Golinelli Daniela, Sullivan Greer
Department of Psychiatry and Behavioral Science, University of Washington School of Medicine at Harborview Medical Center, 326 9th Ave., Seattle, WA 98104, USA.
Am J Psychiatry. 2006 Aug;163(8):1419-25. doi: 10.1176/ajp.2006.163.8.1419.
Despite well-established links between poverty and poor mental illness outcome as well as recent reports exploring racial and ethnic health disparities, little is known about the outcomes of evidence-based psychiatric treatment for poor individuals.
Primary care patients with panic disorder (N=232) who were participating in a randomized controlled trial comparing a cognitive behavior therapy (CBT) and pharmacotherapy intervention to usual care were divided into those patients above (N=152) and below (N=80) the poverty line. Telephone assessments at 3, 6, 9, and 12 months were used to compare the amount of evidence-based care received as well as clinical and functional outcomes.
Poor subjects were more severely ill at baseline, with more medical and psychiatric comorbidity. The increases in the amount of evidence-based care and reductions in clinical symptoms and disability were comparable in the two groups such that poorer individuals, although responding equivalently, continued to be more ill and disabled at 12 months.
The comparable response of poor individuals in this study suggests that standard CBT and pharmacotherapy treatments for panic disorder do not need to be "tailored" to be effective in poor populations. However, the more severe illness both at baseline and follow-up in these poor individuals suggests that treatment programs may need to be extended in order to treat residual symptoms and disability in these patients so that they might achieve comparable levels of remission.
尽管贫困与精神疾病不良预后之间的关联已得到充分证实，且近期有报告探讨了种族和族裔健康差异，但对于贫困个体循证精神治疗的结果却知之甚少。
参与一项将认知行为疗法（CBT）和药物治疗干预与常规治疗进行比较的随机对照试验的惊恐障碍初级护理患者（N = 232）被分为贫困线以上（N = 152）和贫困线以下（N = 80）两组。在3、6、9和12个月时进行电话评估，以比较接受的循证护理量以及临床和功能结局。
贫困受试者在基线时病情更严重，有更多的内科和精神科合并症。两组在循证护理量的增加以及临床症状和残疾程度的降低方面相当，以至于贫困个体虽然反应相当，但在12个月时仍病得更重且残疾程度更高。
本研究中贫困个体的类似反应表明，用于惊恐障碍的标准CBT和药物治疗无需“量身定制”即可在贫困人群中有效。然而，这些贫困个体在基线和随访时病情更严重，这表明可能需要延长治疗方案以治疗这些患者的残留症状和残疾，以便他们可能达到相当的缓解水平。
