Aged Mental Health Research Unit, School of Psychology and Psychiatry, Monash University, Melbourne, Australia.
Int J Geriatr Psychiatry. 2012 Nov;27(11):1163-71. doi: 10.1002/gps.3762. Epub 2012 Feb 17.
This cluster randomized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia.
Three hundred and eighty nine aged care residents were screened for dementia and major depression. Forty four were ultimately included in the intervention sample, selected from 20 aged care facilities located in Melbourne, Australia. Facilities were randomly allocated to an intervention condition involving the provision of multidisciplinary specialist consultation regarding the best-practice management of depression in dementia, or to a care as usual condition. Consultations involved individually tailored medical and psychosocial recommendations provided to care staff and general practitioners. All residents participated in a comprehensive pre-intervention diagnostic assessment, including the administration of the Cornell Scale for Depression in Dementia. This assessment was repeated approximately 15 weeks post-intervention by a rater blind to study condition.
Multidisciplinary specialist mental health consultation was significantly more effective than care as usual in treating the clinical depression of aged care residents with dementia (p < 0.05, partial η(2) = 0.16). At follow-up, the mean Cornell Scale for Depression in Dementia score for the intervention group was 9.47, compared with 14.23 for the control group. In addition, 77% of the intervention group no longer met criteria for major depression.
The results of this study suggest that the psychosocial and medical management of depressed aged care residents can be improved by increasing access to specialist mental health consultation.
本集群随机对照试验旨在确定多学科专家心理健康咨询是否比常规护理更能有效治疗患有痴呆的老年护理居民的抑郁症。
对 389 名老年护理居民进行痴呆和重度抑郁症筛查。最终有 44 名患者被纳入干预样本，他们来自澳大利亚墨尔本的 20 家老年护理机构。这些机构被随机分配到干预组，接受多学科专家咨询，以获得关于痴呆患者最佳抑郁症管理的建议，或接受常规护理。咨询包括为护理人员和全科医生提供个性化的医学和心理社会建议。所有居民均参加了全面的干预前诊断评估，包括进行康奈尔痴呆抑郁量表评估。大约在干预后 15 周，由一位对研究条件不知情的评估者重复评估。
多学科专家心理健康咨询在治疗老年痴呆症患者的临床抑郁症方面明显优于常规护理（p < 0.05，部分η² = 0.16）。在随访时，干预组的康奈尔痴呆抑郁量表平均得分为 9.47，而对照组得分为 14.23。此外，干预组 77%的患者不再符合重度抑郁症的诊断标准。
本研究结果表明，通过增加专家心理健康咨询的机会，可以改善抑郁老年护理居民的社会心理和医疗管理。
