Angstman Kurt B, Wade Todd W, Dejesus Ramona S, Maclaughlin Kathy L, Angstman Gregory L
Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Ment Health Fam Med. 2013 Jan;10(1):15-21.
Objective The primary aim of this study was to determine whether enrolment in collaborative care management (CCM) for treatment of major depression would have a significant impact on 6-month changes in weight compared with patients treated by their primary care provider with usual care. The secondary aim was to determine whether clinical remission would also affect 6-month weight changes. Design A retrospective chart review study included 1550 patients who had been diagnosed with major depression or dysthymia and who had a Patient Health Questionnaire (PHQ-9) score of ≥ 10 with follow-up data (PHQ-9 score and weight) at 6 months. Subjects The study sample consisted of adult patients (aged ≥ 18 years) from primary care practices, representing all body mass index (BMI) categories. The exclusion criteria were a diagnosis of bipolar disorder, recent obstetric delivery or recent gastric bypass procedure. Measurements Weight was measured at index and 6 months, with BMI calculated from electronic medical record data. Patient assessment data (including PHQ-9 score and clinical diagnosis) and demographic variables (age, gender, marital status and clinical location) were also collected. Results With regression modelling, neither enrolment in CCM (P = 0.306) nor clinical remission (P = 0.828) was associated with a significant weight gain. Conclusion After 6 months, enrolment in CCM had no significant impact on weight gain or weight loss among patients treated for depression, nor was improvement to clinical remission a factor in the patient's weight after 6 months. Incorporating a weight loss management intervention within the model may be warranted if concomitant weight reduction is desired.
目的 本研究的主要目的是确定与接受初级保健提供者常规治疗的患者相比,参与协作式护理管理(CCM)治疗重度抑郁症是否会对6个月时的体重变化产生显著影响。次要目的是确定临床缓解是否也会影响6个月时的体重变化。 设计 一项回顾性病历审查研究纳入了1550名被诊断为重度抑郁症或心境恶劣障碍且患者健康问卷(PHQ-9)得分≥10且有6个月随访数据(PHQ-9得分和体重)的患者。 研究对象 研究样本包括来自初级保健机构的成年患者(年龄≥18岁),涵盖所有体重指数(BMI)类别。排除标准为双相情感障碍诊断、近期产科分娩或近期胃旁路手术。 测量指标 在基线和6个月时测量体重,并根据电子病历数据计算BMI。还收集了患者评估数据(包括PHQ-9得分和临床诊断)以及人口统计学变量(年龄、性别、婚姻状况和临床地点)。 结果 通过回归模型分析,参与CCM(P = 0.306)和临床缓解(P = 0.828)均与显著体重增加无关。 结论 6个月后,参与CCM对抑郁症治疗患者的体重增加或减轻没有显著影响,临床缓解也不是6个月后患者体重的影响因素。如果希望同时减轻体重,在该模式中纳入体重管理干预可能是必要的。