Ruesch Miriam, Helmes Almut, Bengel Juergen
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany.
BMC Psychiatry. 2017 Oct 10;17(1):340. doi: 10.1186/s12888-017-1494-9.
Depressive and adjustment disorders are highly prevalent in patients with physical diseases and are associated with poorer quality of life, increased morbidity and mortality, as well as higher healthcare costs. Access to mental health care holds strong importance for these patients, although waiting times for outpatient individual psychotherapy in Germany are often long. Attending an intervention while waiting for individual therapy could improve this problem. For this purpose, we developed an eight-session cognitive behavioral group therapy (STEpS) and tested its efficacy in a randomized controlled trial.
Seventy-six patients with chronic physical diseases and comorbid depressive or adjustment disorders were randomized to either STEpS or a waiting list control group. The primary outcome was self-reported depression measured by the Hospital Anxiety and Depression Scale (HADS-D), while the secondary outcomes included global psychological distress and health-related quality of life. Data was assessed at baseline, post-treatment and 2-month follow-up and was analyzed based on intention-to-treat.
Compared to the control group, the STEpS group showed significantly less depression (d = 0.37; p = .009) and significantly higher quality of life (mental: d = 0.47; p = .030; physical: d = 0.70; p = .001) at post-treatment. The groups did not differ in global psychological distress. At 2-month follow-up, the STEpS group indicated significantly higher subjective physical health (d = 0.43; p = .046), but did not differ from the control group in the remaining outcomes.
STEpS proved effective in improving depression and health-related quality of life in the short term but did not reveal effects on mental outcomes at 2-month follow-up. Nonetheless, the implementation of STEpS as a waiting list intervention prior to individual therapy could help patients to handle long waiting periods in outpatient care.
German Clinical Trials Register DRKS00005140 (27 August 2013).
抑郁和适应障碍在躯体疾病患者中极为普遍，与生活质量较差、发病率和死亡率增加以及医疗保健成本较高相关。获得心理健康护理对这些患者至关重要，尽管在德国门诊个体心理治疗的等待时间往往很长。在等待个体治疗期间参加一项干预措施可能会改善这一问题。为此，我们开发了一个为期八节的认知行为团体治疗（STEpS），并在一项随机对照试验中测试了其疗效。
76例患有慢性躯体疾病且合并抑郁或适应障碍的患者被随机分为STEpS组或等待名单对照组。主要结局是通过医院焦虑抑郁量表（HADS-D）自我报告的抑郁情况，次要结局包括总体心理困扰和健康相关生活质量。在基线、治疗后和2个月随访时评估数据，并基于意向性分析进行分析。
与对照组相比，STEpS组在治疗后抑郁显著减轻（d = 0.37；p = 0.009），生活质量显著提高（心理方面：d = 0.47；p = 0.030；身体方面：d = 0.70；p = 0.001）。两组在总体心理困扰方面没有差异。在2个月随访时，STEpS组主观身体健康显著更高（d = 0.43；p = 0.046），但在其余结局方面与对照组没有差异。
STEpS在短期内被证明对改善抑郁和健康相关生活质量有效，但在2个月随访时未显示对心理结局有影响。尽管如此，在个体治疗之前将STEpS作为等待名单干预措施实施，可能有助于患者应对门诊护理中的长时间等待。
德国临床试验注册中心DRKS00005140（2013年8月27日）。
