Nollett Claire L, Bray Nathan, Bunce Catey, Casten Robin J, Edwards Rhiannon T, Hegel Mark T, Janikoun Sarah, Jumbe Sandra E, Ryan Barbara, Shearn Julia, Smith Daniel J, Stanford Miles, Xing Wen, Margrain Tom H
School of Optometry and Vision Sciences Cardiff University, Cardiff, United Kingdom.
Centre for Health Economics and Medicines Evaluation, School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Gwynedd, United Kingdom.
Invest Ophthalmol Vis Sci. 2016 Aug 1;57(10):4247-54. doi: 10.1167/iovs.16-19345.
The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient's physician, with a waiting-list control group in people with sight loss and depressive symptoms.
This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person's physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.'s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory.
At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London.
Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large.
本研究旨在比较针对视力丧失且伴有抑郁症状者的两种抑郁症干预措施，即问题解决疗法（PST）和转介至患者的医生处，并与等待名单对照组进行对比。
这是一项评估者盲法、探索性、多中心随机临床试验，并同时进行经济分析。在英国14家低视力康复中心连续就诊的1008名患者中，43%（n = 430）在老年抑郁量表上筛查出抑郁症状呈阳性，其中85名患者参与了试验。符合条件的参与者按1:1:1的比例随机分配至PST组、转介至其医生处组或等待名单对照组。PST是一种由训练有素的治疗师实施的手册化谈话干预措施，治疗师会在六至八次疗程中教导患者采用七步法来解决他们的问题。转介至医生处包括向患者的医生发送一封转诊信，鼓励其根据英国国家卫生与临床优化研究所推荐的逐步护理方案考虑进行治疗。主要结局是根据贝克抑郁量表确定的（基线后6个月）抑郁症状变化。
6个月时，等待名单对照组、转介组和PST组的贝克抑郁量表得分分别降低了1.05（标准差8.85）、2.11（标准差7.60）和2.68（标准差7.93）。PST干预措施在威尔士的每位患者成本为1176英镑，在伦敦为1296英镑。
PST组的抑郁症状改善最为明显，而对照组改善最少。然而，变化较小且测量的不确定性相对较大。
