Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Postgrad Med. 2011 Sep;123(5):122-8. doi: 10.3810/pgm.2011.09.2467.
Clinical response and remission for the treatment of depression has been shown to be improved utilizing collaborative care management (CCM). Prior studies have indicated that the presence of mental health comorbidities noted by self-rated screening tools at the intake for CCM are associated with worsening outcomes; few have examined directly the impact of age on clinical response and remission. The hypothesis was that when controlling for other mental health and demographic variables, the age of the patient at implementation of CCM does not significantly impact clinical outcome, and that CCM shows consistent efficacy across the adult age spectrum. We performed a retrospective chart analysis of a cohort of 574 patients with a clinical diagnosis of major depression (not dysthymia) treated in CCM who had 6 months of follow-up data. Using the age group as a categorical variable in logistic regression models demonstrated that while maintaining control of all other variables, age grouping remained a nonsignificant predictor of clinical response (P ≥ 0.1842) and remission (P ≥ 0.1919) after 6 months of treatment. In both models, a lower Generalized Anxiety Disorder-7 score and a negative Mood Disorder Questionnaire score were predictive of clinical response and remission. However, the initial Patient Health Questionnaire-9 score was a statistically significant predictor only for clinical remission (P = 0.0094), not for response (P = 0.0645), at 6 months. In a subset (n = 295) of the study cohort, clinical remission at 12 months was also not associated with age grouping (P ≥ 0.3355). The variables that were predictive of remission at 12 months were the presence of clinical remission at 6 months (odds ratio [OR], 7.4820; confidence interval [CI], 3.9301-14.0389; P < 0.0001), clinical response (with persistent symptoms) (OR, 2.7722; CI, 1.1950-6.4313; P = 0.0176), and a lower initial Patient Health Questionnaire-9 score (OR, 0.9121; CI, 0.8475-0.9816; P = 0.0140). Our study suggests that using CCM for depression treatment may transcend age-related differences in depression and result in positive outcomes regardless of age.
利用协作式护理管理（CCM）治疗抑郁症的临床反应和缓解率得到了改善。先前的研究表明，在 CCM 入组时，自我评估筛查工具所记录的精神健康合并症与预后恶化有关；但很少有研究直接研究年龄对临床反应和缓解的影响。假设是，在控制其他心理健康和人口统计学变量的情况下，患者实施 CCM 的年龄不会显著影响临床结果，并且 CCM 在整个成年年龄范围内均具有一致的疗效。我们对 574 例患有临床诊断为重度抑郁症（非恶劣心境）的患者进行了回顾性图表分析，这些患者接受了 CCM 治疗，并具有 6 个月的随访数据。在逻辑回归模型中，将年龄组作为分类变量使用表明，在控制所有其他变量的情况下，年龄分组仍然不是临床反应（P≥0.1842）和缓解（P≥0.1919）的显著预测因素，在 6 个月的治疗后。在两个模型中，较低的广泛性焦虑症 7 分和负面的心境障碍问卷评分均是临床反应和缓解的预测因素。但是，初始的患者健康问卷 9 分仅对临床缓解（P=0.0094）具有统计学意义，而对反应（P=0.0645）没有统计学意义，在 6 个月时。在研究队列的一个子集中（n=295），12 个月时的临床缓解也与年龄分组无关（P≥0.3355）。12 个月时预测缓解的变量是 6 个月时的临床缓解（比值比[OR]，7.4820；置信区间[CI]，3.9301-14.0389；P<0.0001），临床反应（伴有持续症状）（OR，2.7722；CI，1.1950-6.4313；P=0.0176）和较低的初始患者健康问卷 9 分（OR，0.9121；CI，0.8475-0.9816；P=0.0140）。我们的研究表明，使用 CCM 治疗抑郁症可能超越与年龄相关的抑郁症差异，并产生积极的结果，而与年龄无关。
