Weill Cornell Institute of Geriatric Psychiatry (DSJ, SB, JAS, CP, NS, AC, GSA), White Plains, NY.
Weill Cornell Institute of Geriatric Psychiatry (DSJ, SB, JAS, CP, NS, AC, GSA), White Plains, NY; and the Weill Cornell Department of Healthcare Policy and Research (SB, YW), White Plains, NY.
Am J Geriatr Psychiatry. 2019 May;27(5):502-511. doi: 10.1016/j.jagp.2018.12.004. Epub 2018 Dec 7.
Clinically significant depression occurs in approximately 40% of chronic obstructive pulmonary disease (COPD) patients, and both illnesses severely impair quality of life. This study tests the hypothesis that problem-solving integrated with a treatment adherence intervention, the Problem Solving-Adherence (PSA), is superior to a personalized treatment adherence intervention, the Personalized Intervention for Depressed Patients with COPD (PID-C), alone in improving quality of life in depressed COPD patients.
After screening 633 admissions for acute rehabilitation, we studied quality of life in 87 participants with major depression (by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and severe COPD randomly assigned to 14 sessions of PID-C or PSA over 26 weeks. Quality of life was assessed using the Word Health Organization Quality of Life-BREF at baseline and weeks 10, 14, and 26.
The hypothesis was not supported. Exploratory latent class growth modeling identified two quality of life trajectories. In 80.5% of participants, quality of life remained unchanged and improved in the remaining 19.5% during the first 14 weeks. Patients with a stable quality trajectory had higher qualityof life at baseline and a stronger sense of personal agency.
Maintaining quality of life is a favorable outcome in depressed patients with COPD whose course is one of deterioration. These findings highlight the usefulness of PID-C, an easy to learn, personalized adherence enhancement intervention that, after further testing, may be integrated into the rehabilitation and care of depressed COPD patients.
约 40%的慢性阻塞性肺疾病（COPD）患者患有临床显著抑郁，这两种疾病严重影响生活质量。本研究检验了一个假设，即问题解决与治疗依从性干预相结合的方案（PSA）优于单独使用针对 COPD 抑郁患者的个性化治疗依从性干预（PID-C），可改善抑郁 COPD 患者的生活质量。
在对 633 例急性康复入院患者进行筛选后，我们对 87 名患有重度抑郁症（经精神障碍诊断与统计手册第四版确诊）和严重 COPD 的患者进行了生活质量研究，这些患者被随机分配到为期 26 周的 14 次 PID-C 或 PSA 治疗中。在基线和第 10、14 和 26 周时，使用世界卫生组织生活质量简表评估生活质量。
该假设未得到支持。探索性潜在类别增长模型确定了两种生活质量轨迹。在 80.5%的参与者中，生活质量在最初的 14 周内保持不变，而在其余 19.5%的参与者中得到改善。具有稳定生活质量轨迹的患者在基线时的生活质量更高，并且具有更强的个人代理感。
对于 COPD 合并抑郁的患者来说，生活质量保持不变是一个有利的结果，因为他们的病情会逐渐恶化。这些发现强调了 PID-C 的实用性，这是一种易于学习的个性化增强依从性干预措施，经过进一步测试后，可能会被整合到抑郁 COPD 患者的康复和护理中。
