一项针对老年非裔美国人的基于家庭的干预措施，以减轻抑郁症状和提高生活质量：一项随机试验。
A home-based intervention to reduce depressive symptoms and improve quality of life in older African Americans: a randomized trial.
出版信息
Ann Intern Med. 2013 Aug 20;159(4):243-52. doi: 10.7326/0003-4819-159-4-201308200-00005.
BACKGROUND
Effective care models for treating older African Americans with depressive symptoms are needed.
OBJECTIVE
To determine whether a home-based intervention alleviates depressive symptoms and improves quality of life in older African Americans.
DESIGN
Parallel, randomized trial stratified by recruitment site. Interviewers assessing outcomes were blinded to treatment assignment. (ClinicalTrials.gov: NCT00511680).
SETTING
A senior center and participants' homes from 2008 to 2010.
PATIENTS
African Americans aged 55 years or older with depressive symptoms.
INTERVENTION
A multicomponent, home-based intervention delivered by social workers or a wait-list control group that received the intervention at 4 months.
MEASUREMENTS
Self-reported depression severity at 4 months (primary outcome) and depression knowledge, quality of life, behavioral activation, anxiety, function, and remission at 4 and 8 months.
RESULTS
Of 208 participants (106 and 102 in the intervention and wait-list groups, respectively), 182 (89 and 93, respectively) completed 4 months and 160 (79 and 81, respectively) completed 8 months. At 4 months, participants in the intervention group showed reduced depression severity (difference in mean change in Patient Health Questionnaire-9 score from baseline, -2.9 [95% CI, -4.6 to -1.2]; difference in mean change in Center for Epidemiologic Studies Depression Scale score from baseline, -3.7 [CI, -5.4 to -2.1]); improved depression knowledge, quality of life, behavioral activation, and anxiety (P < 0.001); and improved function (P = 0.014) compared with wait-list participants. More intervention than wait-list participants entered remission at 4 months (43.8% vs. 26.9%). After treatment, control participants showed benefits similar in magnitude to those of participants in the initial intervention group. Those in the initial intervention group maintained benefits at 8 months.
LIMITATION
The study had a small sample, short duration, and differential withdrawal rate.
CONCLUSION
A home-based intervention delivered by social workers could reduce depressive symptoms and enhance quality of life in most older African Americans.
PRIMARY FUNDING SOURCE
National Institute of Mental Health.
背景
需要为患有抑郁症状的老年非裔美国人制定有效的护理模式。
目的
确定基于家庭的干预措施是否可以减轻老年非裔美国人的抑郁症状并改善其生活质量。
设计
按招募地点分层的平行随机试验。评估结果的访谈者对治疗分配不知情。（ClinicalTrials.gov：NCT00511680）。
地点
2008 年至 2010 年期间，一个老年人中心和参与者的家庭。
患者
年龄在 55 岁或以上，有抑郁症状的非裔美国人。
干预
由社会工作者提供的多组分家庭干预措施，或等待列表对照组，该对照组在 4 个月时接受干预。
测量
4 个月时的自我报告抑郁严重程度（主要结局）和抑郁知识、生活质量、行为激活、焦虑、功能和缓解情况，4 个月和 8 个月时。
结果
208 名参与者（干预组和等待列表组各 106 名和 102 名）中，182 名（干预组和等待列表组分别为 89 名和 93 名）完成了 4 个月的随访，160 名（干预组和等待列表组分别为 79 名和 81 名）完成了 8 个月的随访。在 4 个月时，干预组的参与者表现出抑郁严重程度降低（患者健康问卷-9 评分的平均变化差值，从基线下降 2.9[95%CI，从基线下降 4.6 到 1.2]；从基线下降的中心流行病学研究抑郁量表评分的平均变化差值，从基线下降 3.7[CI，从基线下降 5.4 到 2.1]）；抑郁知识、生活质量、行为激活和焦虑方面的改善（P < 0.001）；和改善功能（P = 0.014）与等待列表组相比。与等待列表组相比，更多的干预组参与者在 4 个月时进入缓解期（43.8% vs. 26.9%）。治疗后，对照组参与者表现出与初始干预组参与者相似的获益。初始干预组参与者在 8 个月时保持获益。
局限性
该研究样本量小、持续时间短且退出率存在差异。
结论
由社会工作者提供的基于家庭的干预措施可以减轻大多数老年非裔美国人的抑郁症状并提高其生活质量。
主要资金来源
美国国家心理健康研究所。
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