St. Vincent's Hospital, and University of New South Wales, and The Black Dog Institute, Prince of Wales Hospital, Sydney, Australia.
St. Vincent's Hospital, and University of New South Wales, Sydney, Australia.
Arthritis Care Res (Hoboken). 2018 Jan;70(1):61-70. doi: 10.1002/acr.23257. Epub 2017 Dec 15.
OBJECTIVE: To determine the efficacy of an internet-based cognitive-behavioral therapy (iCBT) program for depression in older adults with osteoarthritis (OA) of the knee and comorbid major depressive disorder (MDD). METHODS: We conducted a randomized controlled trial in 69 adults (ages ≥50 years) meeting criteria for MDD and OA of the knee with 1-week postintervention (week 11) and 3-month followup (week 24) end points. Patients were allocated to either a 10-week iCBT program for depression added to treatment as usual (TAU) or to a TAU control group. Primary outcomes were depression symptoms (9-Item Patient Health Questionnaire [PHQ-9]) and psychological distress (Kessler-10 [K-10]). Secondary outcomes included arthritis self-efficacy (Arthritis Self-Efficacy Scale [ASES]), OA pain, stiffness, physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), and physical and mental health (Short Form 12-Item health survey physical component and mental component summaries). Depression status was assessed by blinded diagnostic interview (the Mini-International Neuropsychiatric Interview) at intake and followup. RESULTS: Intent-to-treat analyses indicated between-group superiority of iCBT over TAU on the primary outcomes (PHQ-9: Hedges g = 1.01, 95% confidence interval [95% CI] 0.47, 1.54; K-10: Hedges g = 0.75, 95% CI 0.23, 1.28), at postintervention and 3-month followup (PHQ-9: Hedges g = 0.90, 95% CI 0.36, 1.44; K-10: Hedges g = 0.94, 95% CI 0.41, 1.48), and on secondary OA-specific measures (ASES: Hedges g = -0.81, 95% CI -0.29, -1.33; WOMAC: Hedges g = 0.56-0.65, 95% CI 0.04, 1.18) at the 3-month followup. The majority of iCBT participants (84%) no longer met diagnostic criteria at 3-month followup. CONCLUSION: Results support the efficacy of an iCBT program (requiring no face-to-face contact) for depression in individuals with comorbid depression and OA of the knee. Importantly, the benefits of the program extended beyond reduced depressive symptoms and distress to include increased self-efficacy and improved pain, stiffness, and physical function at followup.
目的：评估一种基于互联网的认知行为疗法（iCBT）对伴有膝骨关节炎和共病重度抑郁症（MDD）的老年患者抑郁的疗效。
方法：我们对 69 名符合 MDD 和膝骨关节炎标准的成年人（年龄≥50 岁）进行了一项随机对照试验，在干预后 1 周（第 11 周）和 3 个月随访（第 24 周）时进行了评估。患者被分配到接受为期 10 周的 iCBT 治疗（添加到常规治疗中）或常规治疗对照组。主要结局为抑郁症状（9 项患者健康问卷 [PHQ-9]）和心理困扰（Kessler-10 [K-10]）。次要结局包括关节炎自我效能感（关节炎自我效能量表 [ASES]）、骨关节炎疼痛、僵硬、身体功能（西部安大略省和麦克马斯特大学骨关节炎指数 [WOMAC]）以及身体和心理健康（简短的 12 项健康调查的身体成分和心理成分综合评分）。在入组和随访时通过盲法诊断访谈（迷你国际神经精神访谈）评估抑郁状况。
结果：意向治疗分析表明，与常规治疗相比，iCBT 在主要结局（PHQ-9：Hedges g = 1.01，95%置信区间 [95%CI] 0.47，1.54；K-10：Hedges g = 0.75，95%CI 0.23，1.28）、干预后和 3 个月随访（PHQ-9：Hedges g = 0.90，95%CI 0.36，1.44；K-10：Hedges g = 0.94，95%CI 0.41，1.48）和次要的骨关节炎特异性指标（ASES：Hedges g = -0.81，95%CI -0.29，-1.33；WOMAC：Hedges g = 0.56-0.65，95%CI 0.04，1.18）方面均具有优越性，这些指标在 3 个月随访时进行了评估。大多数 iCBT 参与者（84%）在 3 个月随访时不再符合诊断标准。
结论：结果支持在伴有膝骨关节炎和共病重度抑郁症的个体中使用 iCBT 方案（无需面对面接触）治疗抑郁，其疗效确切。重要的是，该方案的益处不仅限于减轻抑郁症状和困扰，还包括在随访时提高自我效能和改善疼痛、僵硬和身体功能。
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