Harvard Medical School, Boston, Massachusetts2Department of Psychiatry, Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, Massachusetts3Biostatistics Center, Massachusetts General Hospital, Boston.
JAMA Intern Med. 2014 Jun;174(6):927-35. doi: 10.1001/jamainternmed.2014.739.
Depression and anxiety are associated with adverse cardiovascular outcomes in patients with recent acute cardiac events. There has been minimal study of collaborative care (CC) management models for mental health disorders in high-risk cardiac inpatients, and no prior CC intervention has simultaneously managed depression and anxiety disorders.
To determine the impact of a low-intensity CC intervention for depression, generalized anxiety disorder, and panic disorder among patients hospitalized for an acute cardiac illness.
DESIGN, SETTING, AND PARTICIPANTS: Single-blind randomized clinical trial, with study assessors blind to group assignment, from September 2010 through July 2013 of 183 patients admitted to inpatient cardiac units in an urban academic general hospital for acute coronary syndrome, arrhythmia, or heart failure and found to have clinical depression, generalized anxiety disorder, or panic disorder on structured assessment.
Participants were randomized to 24 weeks of a low-intensity telephone-based multicomponent CC intervention targeting depression and anxiety disorders (n = 92) or to enhanced usual care (serial notification of primary medical providers; n = 91). The CC intervention used a social work care manager to coordinate assessment and stepped care of psychiatric conditions and to provide support and therapeutic interventions as appropriate.
Improvement in mental health-related quality of life (Short Form-12 Mental Component Score [SF-12 MCS]) at 24 weeks, compared between groups using a random-effects model in an intent-to-treat analysis.
Patients randomized to CC had significantly greater estimated mean improvements in SF-12 MCS at 24 weeks (11.21 points [from 34.21 to 45.42] in the CC group vs 5.53 points [from 36.30 to 41.83] in the control group; estimated mean difference, 5.68 points [95% CI, 2.14-9.22]; P = .002; effect size, 0.61). Patients receiving CC also had significant improvements in depressive symptoms and general functioning, and higher rates of treatment of a mental health disorder; anxiety scores, rates of disorder response, and adherence did not differ between groups.
A novel telephone-based, low-intensity model to concurrently manage cardiac patients with depression and/or anxiety disorders was effective for improving mental health-related quality of life in a 24-week trial.
clinicaltrials.gov Identifier: NCT01201967.
抑郁和焦虑与近期急性心脏事件后患者的不良心血管结局相关。对于高危心脏住院患者的精神疾病的协作护理（CC）管理模式，研究很少，并且以前没有 CC 干预同时管理抑郁和焦虑障碍。
确定一种针对急性心脏疾病住院患者的抑郁、广泛性焦虑障碍和惊恐障碍的低强度 CC 干预措施的影响。
设计、地点和参与者：单盲随机临床试验，研究评估人员对分组情况不知情，于 2010 年 9 月至 2013 年 7 月期间，对 183 名因急性冠状动脉综合征、心律失常或心力衰竭住院的城市学术综合医院的住院心脏病房患者进行研究，这些患者在结构性评估中发现患有临床抑郁症、广泛性焦虑症或惊恐障碍。
参与者被随机分配到为期 24 周的低强度基于电话的多组分 CC 干预，以针对抑郁和焦虑障碍（n=92）或增强的常规护理（定期通知主要医疗提供者；n=91）。CC 干预使用社会工作护理经理来协调评估和精神疾病的阶梯式护理，并提供支持和适当的治疗干预。
24 周时，使用意向治疗分析中的随机效应模型，比较两组之间心理健康相关生活质量（SF-12 心理成分评分[SF-12 MCS]）的改善情况。
接受 CC 随机分组的患者在 24 周时的 SF-12 MCS 估计平均改善幅度显著更大（CC 组从 34.21 分增加到 45.42 分，11.21 分；对照组从 36.30 分增加到 41.83 分，5.53 分；估计平均差异，5.68 分[95%CI，2.14-9.22]；P=0.002；效应大小，0.61）。接受 CC 的患者的抑郁症状和一般功能也有显著改善，精神疾病的治疗率也更高；焦虑评分、疾病反应率和依从性在两组之间没有差异。
一种新的基于电话的、低强度的模型，同时管理患有抑郁和/或焦虑障碍的心脏患者，在 24 周的试验中，有效改善了心理健康相关的生活质量。
clinicaltrials.gov 标识符：NCT01201967。
