Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA.
Am J Public Health. 2019 Jun;109(S3):S205-S213. doi: 10.2105/AJPH.2019.305082.
To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. At 4 years, CEP was more effective than RS at increasing depression remission. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.
为了探索联盟（社区参与和规划[CEP]）与技术援助（服务资源[RS]）对抑郁症协作护理的效果，以及社会决定因素对长期缓解结果的影响。我们在加利福尼亚州洛杉矶县随机分配了 95 个医疗保健和社区项目，分别进行 CEP 或 RS 治疗。2010 年，共有 1246 名患有抑郁症的成年人（PHQ-8≥10）入组，并邀请他们参加基线和 6、12、36 个月的调查。在 598 名 3 年完成者中，有 283 名在 4 年（2016 年）时参加了调查。我们研究了 CEP 与 RS 的效果，以及社会因素（例如家庭收入、食品不安全）对临床缓解（PHQ-8<10）和社区定义缓解（PHQ-8<10 或 PHQ-2<3；心理健康综合评分[MCS-12]>40 或心理健康）的影响。在 3 年的过程中，以及在 4 年时，时间和阶段。我们发现，CEP 与 RS 相比，增加了 4 年的抑郁症缓解率，而对于女性来说，在 3 年的过程中也增加了社区定义的缓解率。社会因素和临床因素预测了缓解。在 4 年时，CEP 比 RS 更有效地增加了抑郁症的缓解率。联盟可能会改善 4 年的抑郁症缓解率，而解决与抑郁症相关的社会和临床因素可能具有提高缓解率的潜力。
