School of Social Work, MRF 102R (MC 0411), University of Southern California, Los Angeles, CA 90089-0411, USA.
Gen Hosp Psychiatry. 2011 Sep-Oct;33(5):436-42. doi: 10.1016/j.genhosppsych.2011.05.018. Epub 2011 Jul 19.
The aim of this study was to determine sustained effectiveness in reducing depression symptoms and improving depression care 1 year following intervention completion.
Of 387 low-income, predominantly Hispanic diabetes patients with major depression symptoms randomized to 12-month socioculturally adapted collaborative care (psychotherapy and/or antidepressants, telephone symptom monitoring/relapse prevention) or enhanced usual care, 264 patients completed 2-year follow-up. Depression symptoms (Symptom Checklist-20 [SCL-20], Patient Health Questionnaire-9 [PHQ-9]), treatment receipt, diabetes symptoms and quality of life were assessed 24 months postenrollment using intent-to-treat analyses.
At 24 months, more intervention patients received ongoing antidepressant treatment (38% vs. 25%, χ(2)=5.11, df=1, P=.02); sustained depression symptom improvement [SCL-20 <0.5 (adjusted odds ratio=2.06, 95% confidence interval=1.09-3.90, P=.03), SCL-20 score (adjusted mean difference -0.22, P=.001) and PHQ-9 ≥50% reduction (adjusted odds ratio=1.87, 95% confidence interval =1.05-3.32, P=.03)]. Over 2 years, improved effects were found in significant study group by time interaction for Short Form-12 mental health, Sheehan Disability Scale (SDS) functional impairment, diabetes symptoms, anxiety and socioeconomic stressors (P=.02 for SDS; P<.0001 for all others); however, group differences narrowed over time and were no longer significant at 24 months.
Socioculturally tailored collaborative care that included maintenance antidepressant medication, ongoing symptom monitoring and behavioral activation relapse prevention was associated with depression improvement over 24 months for predominantly Hispanic patients in primary safety net care.
本研究旨在确定干预完成后 1 年持续减少抑郁症状和改善抑郁治疗的效果。
387 名患有重度抑郁症状的低收入、以西班牙裔为主的糖尿病患者被随机分为 12 个月的社会文化适应性合作护理组（心理治疗和/或抗抑郁药、电话症状监测/复发预防）或强化常规护理组，其中 264 名患者完成了 2 年的随访。使用意向治疗分析，在入组后 24 个月评估抑郁症状（症状清单-20 项 [SCL-20]、患者健康问卷-9 [PHQ-9]）、治疗接受情况、糖尿病症状和生活质量。
在 24 个月时，更多的干预组患者接受了持续的抗抑郁治疗（38%比 25%，χ²（2）=5.11，df=1，P=.02）；持续的抑郁症状改善[SCL-20<0.5（调整后的优势比=2.06，95%置信区间=1.09-3.90，P=.03）]、SCL-20 评分（调整后的平均差异-0.22，P=.001）和 PHQ-9 降低≥50%（调整后的优势比=1.87，95%置信区间=1.05-3.32，P=.03）]。在 2 年期间，在 SCL-20 心理健康、Sheehan 残疾量表（SDS）功能障碍、糖尿病症状、焦虑和社会经济压力源方面，发现了显著的研究组间时间交互作用（SDS：P=.02；所有其他：P<.0001）；然而，组间差异随时间缩小，在 24 个月时不再显著。
针对社会文化背景的合作护理，包括维持抗抑郁药物、持续的症状监测和行为激活复发预防，与主要为西班牙裔的初级安全网护理患者的抑郁改善相关，可持续 24 个月。
