初级保健中基于电话的认知行为疗法的有效性和成本效益：TIDe（电话抑郁症干预）研究方案

Effectiveness and cost-effectiveness of telephone-based cognitive-behavioural therapy in primary care: study protocol of TIDe - telephone intervention for depression.

作者信息

Watzke Birgit, Haller Elisa, Steinmann Maya, Heddaeus Daniela, Härter Martin, König Hans-Helmut, Wegscheider Karl, Rosemann Thomas

机构信息

Department of Psychology - Clinical Psychology and Psychotherapy Research, University of Zurich, Binzmühlestrasse 14/16, Zurich, Switzerland.

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, Germany.

出版信息

BMC Psychiatry. 2017 Jul 19;17(1):263. doi: 10.1186/s12888-017-1429-5.

DOI:10.1186/s12888-017-1429-5

PMID:28724423

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5518124/

Abstract

BACKGROUND

Despite the availability of evidence-based treatments for depression, a large proportion of patients remains untreated or adequate treatment is initiated with delay. This situation is particularly critical in primary care, where not only most individuals first seek help for their mental health problems, but also depressive disorders - particularly mild to moderate levels of severity - are highly prevalent given the high comorbidity of chronic somatic conditions and depression. Improving the access for evidence-based treatment, especially in primary care, is hence a priority challenge in the mental health care agenda. Telephone usage is widespread and has the potential of overcoming many barriers that individuals suffering from mental health problems are facing: Its implementation for treatment delivery presents an option for optimisation of treatment pathways and outcomes.

METHODS/DESIGN: This paper details the study protocol for a randomised controlled trial (RCT) evaluating the effectiveness of a telephone-administered short-term cognitive-behavioural therapy (T-CBT) for depression as compared to treatment as usual (TAU) in the Swiss primary care setting. The study aims at randomising a total of 216 mildly to moderately depressed patients, which are either identified by their General Practitioners (GPs) or who self-refer to the study programme in consultation with their GP. The trial will examine whether telephone-delivered, manualised treatment leads to clinically significant reduction in depression at follow-up. It will further investigate the cost-effectiveness and acceptability of the intervention in the primary care setting.

DISCUSSION

Conducting a low-intensity treatment on the telephone allows for greater flexibility for both patient and therapist, can grant more anonymity and can thus lead to less hesitation in the patient about whether to attempt treatment or not. In order to benefit from this approach, large-scale studies need to prove superior effectiveness and cost-effectiveness of telephone-delivered therapy over routine care for patients with mild to moderate depression.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02667366 . Registered on 3 December 2015.

摘要

背景

尽管有基于证据的抑郁症治疗方法，但仍有很大一部分患者未得到治疗或开始接受充分治疗的时间被推迟。这种情况在初级保健中尤为关键，因为不仅大多数人首先会因心理健康问题寻求帮助，而且鉴于慢性躯体疾病与抑郁症的高共病率，抑郁症——尤其是轻度至中度严重程度的抑郁症——非常普遍。因此，改善基于证据的治疗的可及性，尤其是在初级保健中，是精神卫生保健议程中的一项优先挑战。电话的使用很广泛，并且有可能克服许多患有心理健康问题的人所面临的障碍：将其用于治疗提供是优化治疗途径和结果的一种选择。

方法/设计：本文详细介绍了一项随机对照试验（RCT）的研究方案，该试验评估在瑞士初级保健环境中，与常规治疗（TAU）相比，电话管理的短期认知行为疗法（T-CBT）治疗抑郁症的有效性。该研究旨在将总共216名轻度至中度抑郁症患者随机分组，这些患者要么由他们的全科医生（GP）识别，要么在与他们的GP协商后自行报名参加研究项目。该试验将研究电话提供的、手册化的治疗是否会在随访时导致抑郁症在临床上显著减轻。它还将进一步调查该干预措施在初级保健环境中的成本效益和可接受性。