Unützer Jürgen, Tang Lingqi, Oishi Sabine, Katon Wayne, Williams John W, Hunkeler Enid, Hendrie Hugh, Lin Elizabeth H B, Levine Stuart, Grypma Lydia, Steffens David C, Fields Julie, Langston Christopher
Department of Psychiatry, School of Medicine, University of Washington, Seattle, Washington 98195, USA.
J Am Geriatr Soc. 2006 Oct;54(10):1550-6. doi: 10.1111/j.1532-5415.2006.00882.x.
To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults.
Randomized, controlled trial.
Eighteen diverse primary care clinics.
One thousand eight hundred one adults aged 60 and older with major depression or dysthymia.
Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual.
Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist.
At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available.
Primary care-based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients.
确定一项基于初级保健的抑郁症协作护理计划对老年人自杀意念的影响。
随机对照试验。
18家不同的初级保健诊所。
1801名年龄在60岁及以上的患有重度抑郁症或心境恶劣的成年人。
随机分配到协作护理组的参与者可以获得一名抑郁症护理经理的帮助，该经理会协助其初级保健医生进行抗抑郁药物管理，并提供为期12个月的初级保健问题解决治疗课程。对照组参与者接受常规护理。
参与者在基线时以及第3、6、12、18和24个月时接受抑郁症和自杀意念的独立评估。使用《精神障碍诊断与统计手册》第四版（SCID）的结构化临床访谈来评估抑郁症。使用SCID和霍普金斯症状清单来确定自杀意念。
在基线时，139名（15.3%）干预组受试者和119名（13.3%）对照组受试者报告有自杀念头。在6个月时（7.5%对12.1%）和12个月时（9.8%对15.5%），干预组受试者的自杀意念发生率显著低于对照组，甚至在18个月（8.0%对13.3%）和24个月（10.1%对13.9%）干预资源不再可用后也是如此。两组均无自杀身亡案例。没有关于自杀未遂或因自杀意念住院的信息。
基于初级保健的抑郁症协作护理计划是减少老年初级保健患者自杀意念及潜在自杀风险的一种策略。
