Department of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA.
J Gen Intern Med. 2018 Mar;33(3):347-357. doi: 10.1007/s11606-017-4242-4. Epub 2017 Dec 18.
Patients with limited English proficiency (LEP) have high rates of depression, yet face challenges accessing effective care in outpatient settings. We undertook a systematic review to investigate the effectiveness of the collaborative care model for depression for LEP patients in primary care.
We queried online PubMed, PsycINFO, CINAHL and EMBASE databases (January 1, 2000, to June 10, 2017) for quantitative studies comparing collaborative care to usual care to treat depression in adults with LEP in primary care. We evaluated the impact of collaborative care on depressive symptoms or on depression treatment. Two reviewers independently extracted key data from the studies and assessed risk of bias using the Cochrane bias and quality assessment tool (RCTs) and the Newcastle-Ottawa Quality Assessment Scale (non-RCTs).
Of 86 titles identified, 15 were included (representing 9 studies: 5 RCTs, 3 cohort studies, and 1 case-control study). Studies included 4859 participants; 2679 (55%) reported LEP. The majority spoke Spanish (93%). The wide variability in study design and outcome definitions precluded performing a meta-analysis. Follow-up ranged from 3 months to 2 years. Three of four high-quality RCTs reported that 13-25% more patients had improved depressive symptoms when treated with culturally tailored collaborative care compared to usual care; the last had high treatment in the control arm and found equal improvement. Two non-RCT studies suggest that Spanish-speaking patients may benefit as much as, if not more than, English-speaking patients treated with collaborative care. The remaining studies reported increased receipt of preferred depression treatment (therapy vs. antidepressants) in the intervention groups. Eight of nine studies used bilingual providers to deliver the intervention.
While limited by the number and variability of studies, the available research suggests that collaborative care for depression delivered by bilingual providers may be more effective than usual care among patients with LEP. Implementation studies of collaborative care, particularly among Asian and non-Spanish-speakers, are needed.
有限英语水平（LEP）的患者抑郁症发病率较高，但在门诊环境中获得有效治疗面临挑战。我们进行了一项系统评价，旨在调查协作式护理模式对初级保健中 LEP 患者抑郁症的有效性。
我们在在线 PubMed、PsycINFO、CINAHL 和 EMBASE 数据库（2000 年 1 月 1 日至 2017 年 6 月 10 日）中查询了比较协作式护理与常规护理治疗 LEP 成年人抑郁症的定量研究。我们评估了协作式护理对抑郁症状或抑郁症治疗的影响。两名评审员独立从研究中提取关键数据，并使用 Cochrane 偏倚和质量评估工具（RCTs）和纽卡斯尔-渥太华质量评估量表（非 RCTs）评估偏倚风险。
在 86 个标题中，有 15 个被纳入（代表 9 项研究：5 项 RCTs、3 项队列研究和 1 项病例对照研究）。这些研究共纳入了 4859 名参与者；其中 2679 名（55%）报告有 LEP，他们大多说西班牙语（93%）。由于研究设计和结果定义的巨大差异，无法进行荟萃分析。随访时间从 3 个月到 2 年不等。四项高质量 RCT 中的三项报告说，与常规护理相比，接受文化定制的协作式护理的患者中有 13-25%的患者抑郁症状得到改善；最后一项研究中对照组的治疗效果较高，发现两组改善程度相同。两项非 RCT 研究表明，接受协作式护理的西班牙语患者可能与英语患者一样或更受益。其余研究报告说，干预组患者更愿意接受首选的抑郁症治疗（心理治疗与抗抑郁药物）。九项研究中有八项使用双语提供者提供干预措施。
虽然受到研究数量和变异性的限制，但现有研究表明，由双语提供者提供的协作式护理治疗抑郁症可能比 LEP 患者的常规护理更有效。需要进行协作式护理的实施研究，特别是在亚洲和非西班牙语患者中。
