School of Social Work, University of Southern California, 669 W. 34th St., Los Angeles, CA 90089-0411, USA.
Psychiatr Serv. 2011 Feb;62(2):162-70. doi: 10.1176/ps.62.2.pss6202_0162.
This study assessed longer-term outcomes of low-income patients with cancer (predominantly female and Hispanic) after treatment in a collaborative model of depression care or in enhanced usual care.
The randomized controlled trial, conducted in safety-net oncology clinics, recruited 472 patients with major depression symptoms. Patients randomly assigned to a 12-month intervention (a depression care manager and psychiatrist provided problem-solving therapy, antidepressants, and symptom monitoring and relapse prevention) or enhanced usual care (control group) were interviewed at 18 and 24 months after enrollment.
At 24 months, 46% of patients in the intervention group and 32% in the control group had a ≥50% decrease in depression score over baseline (odds ratio=2.09, 95% confidence interval=1.13-3.86; p=.02); intervention patients had significantly better social (p=.03) and functional (p=.01) well-being. Treatment receipt among intervention patients declined (72%, 21%, and 18% at 12, 18, and 24 months, respectively); few control group patients reported treatment receipt (10%, 6%, and 13%, respectively). Significant differences in receipt of counseling or antidepressants disappeared at 24 months. Depression recurrence was similar between groups (intervention, 36%; control, 39%). Among patients with depression recurrence, intervention patients were more likely to receive treatment after 12 months (34% versus 10%; p=.03). At 24 months, attrition (262 patients, 56%) did not vary by group; 22% were deceased, 20% declined further participation, and 14% could not be located.
Collaborative care reduced depression symptoms and enhanced quality of life; however, results call for ongoing depression symptom monitoring and treatment for low-income cancer survivors.
本研究评估了在抑郁护理协作模式或增强常规护理下接受治疗的低收入癌症患者（主要为女性和西班牙裔）的长期预后。
这项在医疗保障诊所进行的随机对照试验共招募了 472 名有重度抑郁症状的患者。将随机分配至 12 个月干预组（抑郁护理经理和精神科医生提供问题解决治疗、抗抑郁药以及症状监测和复发预防）或增强常规护理组（对照组）的患者，在入组后 18 个月和 24 个月接受访谈。
在 24 个月时，干预组 46%的患者和对照组 32%的患者的抑郁评分基线下降≥50%（比值比=2.09，95%置信区间=1.13-3.86；p=.02）；干预组患者的社会（p=.03）和功能（p=.01）健康状况明显改善。干预组患者的治疗接受率下降（12、18 和 24 个月时分别为 72%、21%和 18%）；对照组患者接受治疗的比例较低（分别为 10%、6%和 13%）。在 24 个月时，接受咨询或抗抑郁药治疗的差异消失。两组的抑郁复发率相似（干预组 36%；对照组 39%）。在抑郁复发的患者中，干预组在 12 个月后更有可能接受治疗（34%比 10%；p=.03）。在 24 个月时，脱落率（262 名患者，56%）无组间差异；22%的患者死亡，20%的患者拒绝进一步参与，14%的患者无法找到。
协作护理可减轻抑郁症状并提高生活质量；然而，结果表明需要持续监测和治疗低收入癌症幸存者的抑郁症状。
