Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Clinical Psychology and Psychotherapy Research, Institute of Psychology, University of Zurich, Binzmühlestrasse 14/16, CH-8050, Zurich, Switzerland.
Sci Rep. 2018 Jun 20;8(1):9389. doi: 10.1038/s41598-018-27470-6.
Guidelines recommend stepped and collaborative care models (SCM) for depression. We aimed to evaluate the effectiveness of a complex guideline-based SCM for depressed patients. German primary care units were cluster-randomised into intervention (IG) or control group (CG) (3:1 ratio). Adult routine care patients with PHQ-9 ≥ 5 points could participate and received SCM in IG and treatment as usual (TAU) in CG. Primary outcome was change in PHQ-9 from baseline to 12 months (hypothesis: greater reduction in IG). A linear mixed model was calculated with group as fixed effect and practice as random effect, controlling for baseline PHQ-9 (intention-to-treat). 36 primary care units were randomised to IG and 13 to CG. 36 psychotherapists, 6 psychiatrists and 7 clinics participated in SCM. 737 patients were included (IG: n = 569 vs. CG: n = 168); data were available for 60% (IG) and 64% (CG) after 12 months. IG showed 2.4 points greater reduction [95% confidence interval (CI): -3.4 to -1.5, p < 0.001; Cohen's d = 0.45] (adjusted PHQ-9 mean change). Odds of response [odds ratio: 2.8; 95% CI: 1.6 to 4.7] and remission [odds ratio: 3.2; 95% CI: 1.58 to 6.26] were higher in IG. Guideline-based SCM can improve depression care.
指南推荐采用递进式和协作式护理模式（SCM）来治疗抑郁症。我们旨在评估一种基于复杂指南的 SCM 对抑郁患者的有效性。德国初级保健单位以 3:1 的比例被随机分为干预组（IG）或对照组（CG）。成年常规护理患者 PHQ-9≥5 分可参加研究，IG 组接受 SCM，CG 组接受常规治疗（TAU）。主要结局是 PHQ-9 从基线到 12 个月的变化（假设：IG 组的降幅更大）。采用线性混合模型进行计算，组为固定效应，实践为随机效应，控制基线 PHQ-9（意向治疗）。36 个初级保健单位被随机分配到 IG 组和 CG 组。36 名心理治疗师、6 名精神科医生和 7 个诊所参与了 SCM。共纳入 737 名患者（IG：n=569 与 CG：n=168）；12 个月后，IG 组有 60%（n=341）和 CG 组有 64%（n=107）的数据可用。IG 组的 PHQ-9 评分降低了 2.4 分[95%置信区间（CI）：-3.4 至-1.5，p<0.001；Cohen's d=0.45]（调整后的 PHQ-9 平均变化）。IG 组的反应[比值比：2.8；95%CI：1.6 至 4.7]和缓解[比值比：3.2；95%CI：1.58 至 6.26]的几率更高。基于指南的 SCM 可以改善抑郁护理。
