Martínez Vania, Rojas Graciela, Martínez Pablo, Gaete Jorge, Zitko Pedro, Vöhringer Paul A, Araya Ricardo
Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Faculty of Medicine, Universidad de Chile, Santiago, Chile.
Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago, Chile.
Front Psychiatry. 2019 Jul 30;10:552. doi: 10.3389/fpsyt.2019.00552. eCollection 2019.
Evidence from developed countries shows the efficacy of computer-assisted cognitive-behavioral therapy (cCBT) in addressing adolescent depression in home and/or school settings. This paper presents the results of a randomized controlled trial (RCT) of a brief therapist-guided cCBT intervention for adolescent depression in resource-constrained primary health care (PHC) settings. A multicenter, two-arm parallel-group, individually RCT with a 1:1 allocation ratio assigned 216 depressed adolescents (aged 15-19) attending four PHC centers in a low-income municipality of Santiago, Chile, to receive eight weekly face-to-face therapist-guided cCBT sessions by study therapists (N = 108), or to receive an enhanced usual care (EUC) intervention by trained PHC psychologists, encouraged to adhere to the national clinical guidelines for the management of depression (N = 108). Both groups received pharmacotherapy concordant with these guidelines. The primary outcome was the Beck Depression Inventory (BDI) at 4 months post-randomization, to assess depressive symptoms. BDI at 6 months post-randomization was a secondary outcome. Additional measures included patients' compliance, and satisfaction with different treatment components, at 6 months post-randomization. The adjusted difference in mean BDI score between groups was -3.75 (95% CI -6.23 to -1.28; p = 0.003) at 4 months post-randomization. At 6 months post-randomization, the adjusted difference in mean BDI score between groups was -2.31 (95% CI -4.89 to 0.27; p = 0.078). The effect size was small-to-medium at 4 months post-randomization, d = 0.39 (0.12 to 0.67), and small and non-significant at 6 months post-randomization d = 0.29 (-0.00 to 0.59). Adolescents in the experimental treatment group were significantly more satisfied with treatment, with the PHC centers' facilities, with the psychological care received, and with non-professional staff than those in the comparator treatment group. A brief therapist-guided cCBT eight-session intervention improves the response of depressed adolescents attending PHC centers at 4 months post-randomization. At 6 months post-randomization, the differences of between groups were not significant. Future research may focus on exploring strategies to sustain and increase response. www.ClinicalTrials.gov, identifier NCT01862913 and URL: https://clinicaltrials.gov/ct2/show/NCT01862913.
发达国家的证据表明，计算机辅助认知行为疗法（cCBT）在家庭和/或学校环境中治疗青少年抑郁症方面具有疗效。本文介绍了一项随机对照试验（RCT）的结果，该试验针对资源有限的初级卫生保健（PHC）环境中的青少年抑郁症开展了一项由治疗师指导的简短cCBT干预。这是一项多中心、双臂平行组、个体随机对照试验，分配比例为1:1，将智利圣地亚哥一个低收入城市的四个初级卫生保健中心的216名抑郁青少年（年龄在15 - 19岁）分为两组，一组由研究治疗师提供为期八周的每周一次面对面治疗师指导的cCBT疗程（N = 108），另一组由经过培训的初级卫生保健心理学家提供强化常规护理（EUC）干预，并鼓励其遵循国家抑郁症管理临床指南（N = 108）。两组均接受符合这些指南的药物治疗。主要结局是随机分组后4个月时的贝克抑郁量表（BDI），用于评估抑郁症状。随机分组后6个月时的BDI是次要结局。其他测量指标包括随机分组后6个月时患者的依从性以及对不同治疗组成部分的满意度。随机分组后4个月时，两组间BDI平均得分的调整差异为 -3.75（95%CI -6.23至 -1.28；p = 0.003）。随机分组后6个月时，两组间BDI平均得分的调整差异为 -2.31（95%CI -4.89至0.27；p = 0.078）。随机分组后4个月时效应大小为中到小，d = 0.39（0.12至0.67），随机分组后6个月时效应大小为小且无统计学意义，d = 0.29（-0.00至0.59）。与对照治疗组相比，实验治疗组的青少年对治疗、初级卫生保健中心的设施、所接受的心理护理以及非专业工作人员的满意度明显更高。一项由治疗师指导的简短八节cCBT干预可改善初级卫生保健中心抑郁青少年在随机分组后4个月时的反应。随机分组后6个月时，组间差异无统计学意义。未来研究可侧重于探索维持和增强反应的策略。ClinicalTrials.gov，标识符NCT01862913，网址：https://clinicaltrials.gov/ct2/show/NCT01862913 。
