Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany.
Curr Opin Psychiatry. 2012 Sep;25(5):405-14. doi: 10.1097/YCO.0b013e3283556c63.
Depression is common in medically ill patients and associated with a negative prognosis. Recent findings indicate that single interventions have little effect on outcomes in these patients. Alternatively, complex interventions based on a collaborative care model are promising. This review summarizes recent findings regarding collaborative care in medically ill patients with comorbid depression.
Recent trials provide evidence for a significantly beneficial effect on depression outcomes with moderate effect sizes regarding depressive symptoms [standardized mean differences (SMDs): -0.46 to -0.74, n = 5] and depression response [odds ratios (ORs): 1.29 to 4.75, n = 6]. Psychosocial quality of life (SMDs: 0.09 to 0.54, n = 5) and satisfaction with care (ORs: 2.55-7.43, n = 3; SMDs: 0.05 and 0.2, n = 1) were increased in intervention patients compared with usual care, whereas physical quality of life (SMDs: -0.17 to 0.06) was not. The evidence regarding medication adherence and somatic, disease-specific outcomes is sparse and conclusions cannot be drawn so far.
Collaborative care interventions are efficacious in medically ill patients with depression. However, there is no data concerning their cost-effectiveness. Furthermore, as trials on collaborative care comprise a heterogeneous set of components, the most effective characteristics should be identified. Moreover, these interventions should be adapted to other healthcare systems than the United States.
患有躯体疾病的患者常并发抑郁，且预后较差。近期研究表明，单一干预措施对这类患者的结局影响甚微，而基于协作式护理模式的综合干预措施则前景广阔。本综述总结了近期关于合并抑郁的躯体疾病患者协作式护理的研究进展。
近期试验为协作式护理对抑郁结局的有益影响提供了证据，其对抑郁症状（标准化均数差：-0.46 至-0.74，n=5）和抑郁反应（比值比：1.29 至 4.75，n=6）的改善效果具有中等效应量。与常规护理相比，心理社会健康相关生活质量（标准化均数差：0.09 至 0.54，n=5）和护理满意度（比值比：2.55 至 7.43，n=3；标准化均数差：0.05 和 0.2，n=1）升高，而躯体健康相关生活质量（标准化均数差：-0.17 至 0.06）则无差异。目前，关于药物依从性和躯体疾病特异性结局的证据还很有限，因此尚无法得出结论。
协作式护理干预对患有抑郁的躯体疾病患者有效。然而，关于其成本效益比，目前尚无数据。此外，由于协作式护理试验包含了各种不同的干预内容，因此应明确最有效的干预特征。另外，还需对这些干预措施进行调整，使其适应除美国以外的其他医疗体系。
