Ell Kathleen, Oh Hyunsung, Lee Pey-Jiuan, Guterman Jeffrey
School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
School of Social Work, University of Southern California, Los Angeles, CA (KE, HO, P-JL).
Psychosomatics. 2014 Nov-Dec;55(6):555-65. doi: 10.1016/j.psym.2014.03.007. Epub 2014 Mar 26.
To determine whether evidence-based socioculturally health literate-adapted collaborative depression care improves depression care, depressive symptoms, and quality of life among predominantly Hispanic patients with coronary heart disease.
The 12-month trial included 97 patients with coronary heart disease (79% of eligible patients) who met the depression criteria assessed by the Patient Health Questionnaire-9. Patients were recruited from 3 safety net clinics and offered depression team care by a bilingual clinical social worker and community patient navigator, a consulting psychiatrist, and a primary care physician. The team provided problem-solving therapy (PST) or pharmacotherapy or both, telephone symptom monitoring and behavioral activation, and patient resource navigation support. Recruited patients were given patient and family member health literacy-adapted educational and community resource materials in Spanish or English.
Overall, depression treatment was 74% (PST, 55%; PST plus antidepressant medications, 18%; and antidepressant medications alone, 2%). Nearly half of the patients showed a 50% reduction of the Symptom Checklist-20 (49% at 6 mo and 48% at 12 mo) and of Patient Health Questionnaire-9 score with 47% of patients at 6 months and 43% at 12 months. The 50% improvement in Patient Health Questionnaire and Symptom Checklist-20 score reduction did not vary significantly between patients who received PST or antidepressant only or those who received PST plus antidepressant. The quality of life Short-Form Health Survey SF-12, the Minnesota Living with Heart Failure questionnaire, and the Sheehan Disability Scale outcomes also improved significantly.
Socioculturally literacy-adapted collaborative depression care was accepted by patients with coronary heart disease and improved depression care and symptoms, quality of life, and functional outcomes among predominantly Hispanic patients with heart disease.
确定基于证据的、适应社会文化健康素养的协作式抑郁症护理是否能改善以西班牙裔为主的冠心病患者的抑郁症护理、抑郁症状和生活质量。
这项为期12个月的试验纳入了97名冠心病患者(占符合条件患者的79%),这些患者符合通过患者健康问卷-9评估的抑郁症标准。患者从3家安全网诊所招募,由一名双语临床社会工作者和社区患者导航员、一名咨询精神科医生和一名初级保健医生提供抑郁症团队护理。该团队提供解决问题疗法(PST)或药物治疗或两者结合、电话症状监测和行为激活,以及患者资源导航支持。招募的患者会收到用西班牙语或英语编写的、适应患者和家庭成员健康素养的教育及社区资源材料。
总体而言,抑郁症治疗率为74%(PST治疗占55%;PST加抗抑郁药物治疗占18%;仅抗抑郁药物治疗占2%)。近一半的患者症状清单-20得分降低了50%(6个月时为49%,12个月时为48%),患者健康问卷-9得分降低,6个月时47%的患者如此,12个月时43%的患者如此。仅接受PST或抗抑郁药物治疗的患者与接受PST加抗抑郁药物治疗的患者相比,患者健康问卷得分提高50%以及症状清单-20得分降低的情况并无显著差异。生活质量简表健康调查SF-12、明尼苏达心力衰竭生活问卷和希恩残疾量表的结果也有显著改善。
适应社会文化素养的协作式抑郁症护理为冠心病患者所接受,并改善了以西班牙裔为主的心脏病患者的抑郁症护理及症状、生活质量和功能结局。