长期医疗状况对抑郁和焦虑心理治疗结果的影响。
Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety.
机构信息
Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK
Jaime Delgadillo, PhD, Leeds Community Healthcare NHS Trust and Department of Health Sciences, University of York, York, UK; Alexander Dawson, Leeds Community Healthcare NHS Trust, Leeds; Simon Gilbody, DPhil, FRCPsych, Jan R. Böhnke, Dipl Psych, Dr rer nat, Hull York Medical School, and Department of Health Sciences, University of York, York, UK.
出版信息
Br J Psychiatry. 2017 Jan;210(1):47-53. doi: 10.1192/bjp.bp.116.189027. Epub 2016 Nov 17.
BACKGROUND
Long-term conditions often coexist with depression and anxiety.
AIMS
To assess the effectiveness of stepped-care psychological therapies for patients with long-term conditions.
METHOD
Data from 28 498 patients were analysed using regression to model depression (Patient Health Questionnaire (PHQ-9)) and anxiety (Generalised Anxiety Disorder scale (GAD-7)) outcomes. Post-treatment symptoms and effect sizes (d) were estimated for individuals with and without long-term conditions, controlling for covariates. The likelihood of access and response to intensive psychological interventions was also examined.
RESULTS
Higher post-treatment symptoms were predicted for patients with musculoskeletal problems (d = 0.22-0.27), chronic obstructive pulmonary disease (d = 0.26-0.33), diabetes (d = 0.05-0.13) and psychotic disorders (d = 0.50-0.58). Most long-term conditions were associated with greater odds of accessing high-intensity therapies, yet individuals who accessed these continued to have higher average post-treatment symptoms.
CONCLUSIONS
Some long-term conditions are associated with greater intensity of care and poorer outcomes after therapy.
背景
长期疾病常与抑郁和焦虑共存。
目的
评估分级心理治疗对长期疾病患者的疗效。
方法
使用回归分析对 28498 名患者的数据进行分析，以评估抑郁（患者健康问卷（PHQ-9））和焦虑（广泛性焦虑障碍量表（GAD-7））的治疗效果。对有和没有长期疾病的患者进行治疗后症状和效应量（d）的估计，同时控制协变量。还检查了接受强化心理干预的可能性和反应。
结果
肌肉骨骼问题（d = 0.22-0.27）、慢性阻塞性肺疾病（d = 0.26-0.33）、糖尿病（d = 0.05-0.13）和精神障碍（d = 0.50-0.58）患者的治疗后症状预测更高。大多数长期疾病与接受高强度治疗的几率更高相关，但接受这些治疗的患者的平均治疗后症状仍较高。
结论
一些长期疾病与更高的治疗强度和治疗后较差的结果相关。
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