Ludman Evette J, Simon Gregory E, Tutty Steve, Von Korff Michael
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101-1448, USA.
J Consult Clin Psychol. 2007 Apr;75(2):257-66. doi: 10.1037/0022-006X.75.2.257.
Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients beginning antidepressant treatment versus usual care. In a repeated measures linear model with adjustment for baseline scores, the phone therapy group showed significantly lower mean Hopkins Symptom Checklist (HSCL) Depression Scale scores (L. Derogatis, K. Rickels, E. Uhlenhuth, & L. Covi, 1974) from 6 months to 18 months versus usual care, F(1, 336) = 11.28, p = .001. Average HSCL depression scores over the period from 6 months to 18 months were 0.68 (SD = 0.55) in the telephone therapy group and 0.85 (SD = 0.65) in the usual-care comparison group. Addition of a brief, structured CBT program can significantly improve clinical outcomes for the large number of patients beginning antidepressant treatment in primary care.
关于药物联合心理治疗作为抑郁症初始治疗方法的价值，随机试验证据和专家指南存在分歧。本研究描述了一项随机试验（N = 393）的长期结果，该试验评估了针对开始抗抑郁治疗的初级保健患者，基于电话的认知行为疗法（CBT）加护理管理与常规护理的效果。在一个对基线分数进行调整的重复测量线性模型中，与常规护理相比，电话治疗组在6个月至18个月期间的平均霍普金斯症状清单（HSCL）抑郁量表得分显著更低（L. 德罗加蒂斯、K. 里克斯、E. 乌伦胡特和L. 科维，1974），F(1, 336) = 11.28，p = .001。电话治疗组在6个月至18个月期间的平均HSCL抑郁得分是0.68（标准差 = 0.55），常规护理对照组为0.85（标准差 = 0.65）。增加一个简短、结构化的CBT项目可以显著改善大量在初级保健中开始抗抑郁治疗的患者的临床结局。
