Menezes Paulo, Quayle Julieta, Garcia Claro Heloísa, da Silva Simone, Brandt Lena R, Diez-Canseco Francisco, Miranda J Jaime, Price LeShawndra N, Mohr David C, Araya Ricardo
Population Mental Health Research Centre, Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil.
Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil.
JMIR Ment Health. 2019 Apr 26;6(4):e11698. doi: 10.2196/11698.
Depression is underdiagnosed and undertreated in primary health care. When associated with chronic physical disorders, it worsens outcomes. There is a clear gap in the treatment of depression in low- and middle-income countries (LMICs), where specialists and funds are scarce. Interventions supported by mobile health (mHealth) technologies may help to reduce this gap. Mobile phones are widely used in LMICs, offering potentially feasible and affordable alternatives for the management of depression among individuals with chronic disorders.
This study aimed to explore the potential effectiveness of an mHealth intervention to help people with depressive symptoms and comorbid hypertension or diabetes and explore the feasibility of conducting large randomized controlled trials (RCTs).
Emotional Control (CONEMO) is a low-intensity psychoeducational 6-week intervention delivered via mobile phones and assisted by a nurse for reducing depressive symptoms among individuals with diabetes or hypertension. CONEMO was tested in 3 pilot studies, 1 in São Paulo, Brazil, and 2 in Lima, Peru. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at enrollment and at 6-week follow-up.
The 3 pilot studies included a total of 66 people. Most participants were females aged between 41 and 60 years. There was a reduction in depressive symptoms as measured by PHQ-9 in all pilot studies. In total, 58% (38/66) of the participants reached treatment success rate (PHQ-9 <10), with 62% (13/21) from São Paulo, 62% (13/21) from the first Lima pilot, and 50% (12/24) from the second Lima pilot study. The intervention, the app, and the support offered by the nurse and nurse assistants were well received by participants in both settings.
The intervention was feasible in both settings. Clinical data suggested that CONEMO may help in decreasing participants' depressive symptoms. The findings also indicated that it was possible to conduct RCTs in these settings.
在初级卫生保健中，抑郁症的诊断和治疗不足。当与慢性身体疾病相关时，它会使病情恶化。在中低收入国家（LMICs），抑郁症的治疗存在明显差距，这些国家专科医生和资金匮乏。移动健康（mHealth）技术支持的干预措施可能有助于缩小这一差距。手机在中低收入国家广泛使用，为慢性病患者的抑郁症管理提供了潜在可行且经济实惠的替代方案。
本研究旨在探讨移动健康干预对有抑郁症状且合并高血压或糖尿病患者的潜在效果，并探讨进行大型随机对照试验（RCT）的可行性。
情绪控制（CONEMO）是一种为期6周的低强度心理教育干预，通过手机进行，并由护士协助，以减轻糖尿病或高血压患者的抑郁症状。CONEMO在3项试点研究中进行了测试，1项在巴西圣保罗，2项在秘鲁利马。在入组时和6周随访时使用患者健康问卷-9（PHQ-9）评估抑郁症状。
3项试点研究共纳入66人。大多数参与者为41至60岁的女性。在所有试点研究中，PHQ-9测量的抑郁症状均有所减轻。总体而言，58%（38/66）的参与者达到治疗成功率（PHQ-9<10），其中圣保罗的为62%（13/21），利马第一个试点的为62%（13/21），利马第二个试点研究的为50%（12/24）。在这两种情况下，参与者对干预措施、应用程序以及护士和护士助理提供的支持都给予了好评。
该干预措施在两种情况下都是可行的。临床数据表明，CONEMO可能有助于减轻参与者的抑郁症状。研究结果还表明，在这些情况下进行随机对照试验是可行的。
