专科抑郁服务对持续性中重度抑郁障碍的有效性如何？：一项服务使用者体验的定性研究。
How is a specialist depression service effective for persistent moderate to severe depressive disorder?: a qualitative study of service user experience.
机构信息
Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Yang Fujia Building, Nottingham, NG8 1BB, UK.
CLAHRC-EM, School of Medicine, University of Nottingham, Nottingham, UK.
出版信息
BMC Psychiatry. 2018 Jun 15;18(1):194. doi: 10.1186/s12888-018-1708-9.
BACKGROUND
A specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England. However, there is uncertainty concerning how specialist depression services effect such change. The current study aimed to evaluate the factors which may explain the greater effectiveness of SDS compared to Treatment as Usual (TAU) by exploring the experience of the RCT participants.
METHODS
Qualitative audiotaped and transcribed semi-structured interviews were conducted 12-18 months after baseline with 21 service users (12 SDS, 9 TAU arms) drawn from all three sites. Inductive thematic analysis using a grounded approach contrasted the experiences of SDS with TAU participants.
RESULTS
Four themes emerged in relation to service user experience: 1. Specific treatment components of the SDS: which included sub-themes of the management of medication change, explaining and developing treatment strategies, setting realistic expectations, and person-centred and holistic approach; 2. Individual qualities of SDS clinicians; 3. Collaborative team context in SDS: which included sub-themes of communication between healthcare professionals, and continuity of team members; 4. Accessibility to SDS: which included sub-themes of flexibility of locations, frequent consultation as reinforcement, gradual pace of treatment, and challenges of returning to usual care.
CONCLUSIONS
The study uncovered important mechanisms and contextual factors in the SDS that service users experience as different from TAU, and which may explain the greater effectiveness of the SDS: the technical expertise of the healthcare professionals, personal qualities of clinicians, teamwork, gradual pace of care, accessibility and managing service transitions. Usual care in other specialist mental health services may share many of the features from the SDS.
TRIAL REGISTRATION
"Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder" was registered in www.ClinicalTrials.gov ( NCT01047124 ) on 12-01-2010 and the ISRCTN registry was registered in www.isrctn.com ( ISRCTN10963342 ) on 25-11-2015 (retrospectively registered).
背景
在英格兰的专科精神卫生服务机构中，一项针对持续性抑郁障碍的专家抑郁服务（SDS）提供协作的药物治疗和认知行为治疗，与常规社区多学科护理相比，在一项随机对照试验（RCT）中显示出对抑郁症状的有效性。然而，对于专科抑郁服务如何产生这种变化，目前还存在不确定性。本研究旨在通过探讨 RCT 参与者的经验，评估可能解释 SDS 比治疗性常规护理（TAU）更有效的因素。
方法
在基线后 12-18 个月，从所有三个地点抽取了 21 名服务使用者（12 名 SDS，9 名 TAU 组）进行了定性、录音和转录的半结构化访谈。采用扎根方法进行归纳主题分析，对比 SDS 和 TAU 参与者的经验。
结果
与服务使用者体验相关的四个主题出现：1. SDS 的特定治疗成分：包括药物管理变化、解释和制定治疗策略、设定现实期望、以人为本和整体方法的管理；2. SDS 临床医生的个人特质；3. SDS 协作团队背景：包括医疗保健专业人员之间的沟通、团队成员的连续性等子主题；4. SDS 的可及性：包括地点的灵活性、作为强化的频繁咨询、治疗的渐进节奏以及返回常规护理的挑战等子主题。
结论
该研究揭示了 SDS 中服务使用者体验到的与 TAU 不同的重要机制和背景因素，这可能解释了 SDS 的更高疗效：医疗保健专业人员的技术专长、临床医生的个人特质、团队合作、治疗节奏的渐进性、可及性和服务过渡的管理。其他专科精神卫生服务中的常规护理可能具有 SDS 的许多特点。
试验注册
“对难治性单相抑郁障碍的专科专家情绪障碍团队的临床和成本效益的试验”于 2010 年 1 月 12 日在 www.ClinicalTrials.gov（NCT01047124）注册，ISRCTN 注册于 2015 年 11 月 25 日（追溯性注册）在 www.isrctn.com（ISRCTN10963342）注册。
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