Atlantis Evan, Fahey Paul, Foster Jann
School of Nursing and Midwifery, University of Western Sydney, Campbelltown Campus, Campbelltown, New South Wales, Australia.
BMJ Open. 2014 Apr 12;4(4):e004706. doi: 10.1136/bmjopen-2013-004706.
The collaborative care model is recommended for depression in adults with a chronic physical health problem like diabetes. We sought to systematically assess the effect of collaborative care on depression and glycaemia in adults with comorbid depression and diabetes to inform guidelines and practice.
Systematic review and meta-analysis.
We searched PubMed, Scopus, Cochrane Library, CINAHL, Health Source Nursing, MEDLINE, PsychINFO and reference lists of retrieved articles published before August 2013.
Randomised controlled trials (RCTs) on collaborative care (ie, coordinated multidisciplinary model of care) for depression that reported the effects on depression and glycaemic outcomes in adults with comorbid clinically relevant depression and diabetes were eligible.
Data on the mean difference in depression and glycaemic outcomes were extracted and pooled using random effects meta-analysis.
Seven RCTs included for review reported effects on depression outcomes in 1895 participants, and glycated haemoglobin (HbA1c) level in 1556 participants. Collaborative care significantly improved the depression score (standardised mean difference was -0.32 (95% CI -0.53 to -0.11); I(2)=79%) and HbA1c level (weighted mean difference was -0.33% (95% CI -0.66% to -0.00%); I(2)=72.9%) compared with control conditions. Depression remission did not predict better glycaemic control across studies.
Limited evidence from short-to-medium term RCTs predominantly conducted in the USA suggests that collaborative care for depression significantly improves both depression and glycaemia outcomes, independently, in people with comorbid depression and diabetes.
对于患有糖尿病等慢性身体健康问题的成年人抑郁症，推荐采用协作护理模式。我们试图系统评估协作护理对患有抑郁症和糖尿病的成年人的抑郁及血糖水平的影响，以为指南制定和实践提供参考。
系统评价和荟萃分析。
我们检索了PubMed、Scopus、Cochrane图书馆、CINAHL、健康源护理、MEDLINE、PsychINFO以及2013年8月之前发表的检索文章的参考文献列表。
关于抑郁症协作护理（即协调多学科护理模式）的随机对照试验（RCT），若报告了对患有临床相关抑郁症和糖尿病的成年人的抑郁及血糖结果的影响，则符合要求。
提取抑郁症和血糖结果的平均差异数据，并使用随机效应荟萃分析进行汇总。
纳入综述的7项RCT报告了对1895名参与者的抑郁结果以及1556名参与者的糖化血红蛋白（HbA1c）水平的影响。与对照条件相比，协作护理显著改善了抑郁评分（标准化平均差为-0.32（95%CI -0.53至-0.11）；I² = 79%）和HbA1c水平（加权平均差为-0.33%（95%CI -0.66%至-0.00%）；I² = 72.9%）。在各项研究中，抑郁缓解并未预示更好的血糖控制。
主要在美国进行的短期至中期RCT的有限证据表明，对于患有抑郁症和糖尿病的人，抑郁症的协作护理能独立显著改善抑郁和血糖结果。
