Almeida Osvaldo P, Marsh Kylie, Murray Karen, Hickey Martha, Sim Moira, Ford Andrew, Flicker Leon
Western Australian Centre for Health & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Australia; Department of Psychiatry, Royal Perth Hospital, Australia.
Western Australian Centre for Health & Ageing (M573), Centre for Medical Research of the Perkins Institute for Medical Research, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Australia.
Maturitas. 2016 Oct;92:41-48. doi: 10.1016/j.maturitas.2016.07.012. Epub 2016 Jul 19.
To determine if health coaching (HC) decreases the incidence of depression, reduces the severity of symptoms, and increases quality of life during the menopausal transition (MT).
Parallel, single-blinded, randomised controlled trial of 6 sessions of phone-delivered HC compared with usual care. Participants were 351 community-dwelling women free of major depression going through the MT, of whom 180 were assigned the intervention and 171 usual care. The primary outcome of interest was the incidence of clinically significant depressive symptoms over 52 weeks. Other study measures included the Hospital Anxiety and Depression Scale, quality of life (SF-12), the Menopause Rating Scale (MRS), diet, body mass index, alcohol use, smoking and physical activity. We considered that women with Patient Health Questionnaire (PHQ-9) scores between 5 and 14 (inclusive) had sub-threshold depressive symptoms.
Nine women developed clinically significant symptoms of depression during the study-2 had been assigned HC (odds ratio, OR=0.26, 95%CI=0.05, 1.29; p=0.099). Intention-to-treat showed that, compared with usual care, the intervention led to a greater decline in depressive scores, most markedly for participants with sub-threshold depressive symptoms. Similar, but less pronounced, benefits were noticed for anxiety scores and the mental component summary of the SF-12. The intervention led to a decline in MRS scores by week 26 and subtle improvements in body mass, consumption of vegetables and smoking.
HC addressing relevant risk factors for depression during the MT improves mental health measures. Our findings indicate that women with sub-threshold depressive symptoms may benefit the most from such interventions, and suggest that HC could play a useful role in minimizing mental health disturbance for women going through the MT.
确定健康指导（HC）是否能降低围绝经期过渡（MT）期间抑郁症的发病率，减轻症状严重程度，并提高生活质量。
一项平行、单盲、随机对照试验，将6次电话健康指导与常规护理进行比较。参与者为351名处于围绝经期过渡阶段、无重度抑郁症的社区女性，其中180人被分配接受干预，171人接受常规护理。主要关注的结果是52周内具有临床意义的抑郁症状的发病率。其他研究指标包括医院焦虑抑郁量表、生活质量（SF-12）、更年期评定量表（MRS）、饮食、体重指数、饮酒、吸烟和身体活动。我们认为患者健康问卷（PHQ-9）得分在5至14（含）之间的女性有亚阈值抑郁症状。
在研究期间，9名女性出现了具有临床意义的抑郁症状，其中2人被分配接受健康指导（优势比，OR=0.26，95%置信区间=0.05，1.29；p=0.099）。意向性分析表明，与常规护理相比，干预导致抑郁评分下降幅度更大，对于有亚阈值抑郁症状的参与者最为明显。在焦虑评分和SF-12的心理成分总结方面也观察到了类似但不太明显的益处。干预导致到第26周时MRS评分下降，体重、蔬菜摄入量和吸烟情况有细微改善。
针对围绝经期过渡期间抑郁症相关危险因素的健康指导可改善心理健康指标。我们的研究结果表明，有亚阈值抑郁症状的女性可能从这类干预中获益最大，并表明健康指导在将围绝经期女性的心理健康干扰降至最低方面可能发挥有益作用。
