Bombardier Charles H, Bell Kathleen R, Temkin Nancy R, Fann Jesse R, Hoffman Jeanne, Dikmen Sureyya
Departments of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.
J Head Trauma Rehabil. 2009 Jul-Aug;24(4):230-8. doi: 10.1097/HTR.0b013e3181ad65f0.
To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms.
Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care.
One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit.
The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery.
Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey.
Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls.
Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.
确定一项旨在改善创伤性脑损伤（TBI）后功能的干预措施是否也能减轻抑郁症状。
单盲随机对照试验，将定期电话干预与常规护理进行比较。
171名从住院康复单元出院的TBI患者。
治疗组在9个月内接受多达7次定期电话随访，旨在引出当前的担忧、提供信息并促进与TBI恢复相关领域的问题解决。
简明症状量表-抑郁（BSI-D）子量表、神经行为功能量表-抑郁子量表以及简短36项健康调查中的心理健康指数-5。
126名（74%）参与者有基线BSI-D子量表和结局数据。随机分组有效，但基线时常规护理（对照组）的抑郁症状更严重。结局分析针对这些差异进行了调整。总体而言，从基线到1年，对照组参与者的抑郁症状严重程度比治疗组增加得更多。治疗组在所有结局测量中报告的抑郁症状严重程度显著更低。对于基线时抑郁程度更高的患者，治疗组的症状改善程度比对照组更大。
采用问题解决和行为激活方法的电话干预可能对改善TBI后的抑郁症状有效。主动打电话、动机性访谈以及让重要他人参与干预可能促成了其有效性。
