University of Washington School of Medicine, Seattle, WA, USA.
Int J Geriatr Psychiatry. 2012 Dec;27(12):1298-304. doi: 10.1002/gps.3784. Epub 2012 Feb 27.
Activity scheduling is an established component of evidenced-based treatment for late-life depression in primary care. We examined participant records from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial to identify activity scheduling strategies used in the context of successful depression care management (CM), associations of activity scheduling with self-reported activity engagement, and depression outcomes.
This study used observational mixed methods analysis of 4335 CM session notes from 597 participants in the intervention arm of the IMPACT trial. Grounded theory was used to identify 17 distinct activity categories from CM notes. Logistic regression was used to evaluate associations between activity scheduling, activity engagement, and depression outcomes at 12 months. All relevant institutional review boards approved the research protocol.
Seventeen distinct activity categories were generated. Most patients worked on at least one social and one solitary activity during their course of treatment. Common activity categories included physical activity (32%), medication management (22%), active-non-physical (19%), and passive (14%) activities. We found significant, positive associations between activity scheduling, self-reported engagement in activities at 12 months, and depression outcomes at 12 months.
Older primary care patients in CM for depression worked on a wide range of activities. Consistent with depression theory that has placed emphasis on social activities, the data indicate a benefit for intentional social engagement versus passive social and solitary activities. Care managers should encourage patients to balance instrumental activities (e.g., attending to medical problems) with social activities targeting direct interpersonal engagement.
活动安排是在初级保健中对老年抑郁症进行循证治疗的既定组成部分。我们检查了改善情绪促进协作治疗（IMPACT）试验中的参与者记录，以确定在成功的抑郁症护理管理（CM）背景下使用的活动安排策略、活动安排与自我报告的活动参与度以及抑郁症结果之间的关联。
本研究使用 IMPACT 试验干预组的 597 名参与者的 4335 次 CM 会议记录进行观察性混合方法分析。扎根理论用于从 CM 记录中确定 17 种不同的活动类别。逻辑回归用于评估活动安排、活动参与度和 12 个月时的抑郁结果之间的关联。所有相关机构审查委员会都批准了研究方案。
生成了 17 种不同的活动类别。大多数患者在治疗过程中至少从事一项社交活动和一项单独活动。常见的活动类别包括体育活动（32%）、药物管理（22%）、主动非体育活动（19%）和被动活动（14%）。我们发现活动安排、12 个月时自我报告的活动参与度与 12 个月时的抑郁结果之间存在显著的正相关关系。
在 CM 中接受抑郁症治疗的老年初级保健患者从事了广泛的活动。与强调社交活动的抑郁症理论一致，数据表明有针对性的社交参与与被动社交和单独活动相比对抑郁有益。护理经理应鼓励患者平衡工具性活动（例如，处理医疗问题）和针对直接人际参与的社交活动。
