Center for Victims of Torture, 2356 University Ave W Ste 430, St Paul, MN, 55114, USA.
University of Minnesota, Boyton Health Mental Health Clinic, 410 Church St SE, Minneapolis, MN, 55455, USA.
BMC Fam Pract. 2020 Jan 28;21(1):17. doi: 10.1186/s12875-020-1090-9.
Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.
A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size.
Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001).
Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.
clinicaltrials.gov Identifier: NCT03788408. Registered 20 Dec 2018. Retrospectively registered.
尽管全球难民危机空前，但在初级保健中，几乎没有研究涉及重新安置难民出现严重心理社会需求和复杂症状时的实际情况和更长的治疗过程。我们研究了在初级保健环境中进行一年的心理治疗和病例管理对有抑郁症状的克伦族难民（明尼苏达州圣保罗的新到达人群）常见症状和功能的影响。
在两家拥有大量重新安置的克伦族难民患者群体的初级保健诊所进行了一项实用平行组随机对照试验，采用简单随机分配，为期一年：（1）强化心理治疗和病例管理（IPCM），或（2）常规护理（CAU）。纳入标准包括：由结构化诊断临床访谈确定的重度抑郁症诊断、克伦族难民、年龄在 18-65 岁之间。IPCM（n=112）接受了为期一年的心理治疗和病例管理，由病例经理、心理治疗师和初级保健提供者在现场协调；CAU（n=102）在他们的初级保健诊所接受常规护理，包括行为健康转诊和/或现场干预。盲法评估员在基线、3 个月、6 个月和 12 个月时收集抑郁和焦虑症状（由霍普金斯症状清单-25 测量）、创伤后应激障碍症状（创伤后诊断量表）、疼痛（内部开发的 5 项疼痛量表）和社会功能（内部开发的 37 项难民标准化工具）的平均变化结果。在倾向评分匹配后，使用重复测量方差分析和偏 eta-平方效应量估计，对符合意向治疗原则的数据进行分析。
在 214 名参与者中，有 193 名完成了基线和随访评估（90.2%）。IPCM 患者在所有时间点的抑郁、创伤后应激障碍、焦虑和疼痛症状以及社会功能均有显著改善，且改善程度随时间的推移而增加。CAU 患者没有显示出显著的改善。两组之间观察到的最大平均差异出现在抑郁（差异，5.5，95%置信区间，3.9 至 7.1，P<.001）和基本需求/安全（差异，5.4，95%置信区间，3.8 至 7.0，P<.001）方面。
有抑郁症状的成年克伦族难民从初级保健中协调和提供的强化心理治疗和病例管理中受益。干预效果在每个时间间隔都有所增强，这表明有可能实现强大的康复。
clinicaltrials.gov 标识符：NCT03788408。于 2018 年 12 月 20 日注册。回顾性注册。
