肥胖和抑郁干预对以患者为中心的结局的影响：一项 RCT 研究。
Effect of an Intervention for Obesity and Depression on Patient-Centered Outcomes: An RCT.
机构信息
Department of Epidemiology and Population Health, Stanford University, Palo Alto, California; Department of Medicine, Stanford University, Palo Alto, California.
Sutter Health Research, Sutter Health, Palo Alto, California.
出版信息
Am J Prev Med. 2020 Apr;58(4):496-505. doi: 10.1016/j.amepre.2019.11.005. Epub 2020 Feb 14.
INTRODUCTION
An integrated collaborative care intervention was successful for treating comorbid obesity and depression. The effect of the integrated intervention on secondary outcomes of quality of life and psychosocial functioning were examined, as well as whether improvements in these secondary outcomes were correlated with improvements in the primary outcomes of weight and depressive symptoms.
STUDY DESIGN
This RCT compared an integrated collaborative care intervention for obesity and depression to usual care. Data were analyzed in 2018.
SETTING/PARTICIPANTS: Adult primary care patients (n=409) with a BMI ≥30 (≥27 if Asian) and 9-Item Patient Health Questionnaire score ≥10 were recruited from September 30, 2014 to January 12, 2017 from primary care clinics in Northern California.
INTERVENTION
The 12-month intervention integrated a behavioral weight loss program and problem-solving therapy with as-needed antidepressant medications for depression.
MAIN OUTCOME MEASURES
A priori secondary outcomes included health-related quality of life (Short Form-8 Health Survey), obesity-specific quality of life (Obesity-Related Problems Scale), sleep disturbance and sleep-related impairment (Patient-Reported Outcomes Measurement Information System), and functional disability (Sheehan Disability Scale) at baseline and 6 and 12 months.
RESULTS
Participants randomized to the intervention experienced significantly greater improvements in obesity-specific problems, mental health-related quality of life, sleep disturbance, sleep-related impairment, and functional disability at 6 months but not 12 months. Improvements in obesity-related problems (β=0.01, 95% CI=0.01, 0.02) and sleep disturbance (β= -0.02, 95% CI= -0.04, 0) were associated with lower BMI. Improvements in the physical (β= -0.01, 95% CI= -0.01, 0) and mental health components (β= -0.02, 95% CI= -0.03, -0.02) of the Short Form-8 Health Survey as well as sleep disturbance (β=0.01, 95% CI=0.01, 0.02) and sleep-related impairment (β=0.01, 95% CI=0, 0.01) were associated with fewer depressive symptoms.
CONCLUSIONS
An integrated collaborative care intervention for obesity and depression that was shown previously to improve weight and depressive symptoms may also confer benefits for quality of life and psychosocial functioning over 6 months.
TRIAL REGISTRATION
This study is registered at clinicaltrials.gov NCT02246413.
简介
针对肥胖合并抑郁共病的综合协作式护理干预已被证实有效。本研究旨在考察该综合干预对生活质量和心理社会功能等次要结局的影响，以及这些次要结局的改善是否与体重和抑郁症状等主要结局的改善相关。
研究设计
这是一项肥胖合并抑郁的综合协作式护理干预与常规护理的 RCT 对比研究。数据分析于 2018 年进行。
研究地点/参与者：2014 年 9 月 30 日至 2017 年 1 月 12 日，从北加利福尼亚州的基层医疗诊所招募了 409 名成年初级保健患者（BMI≥30（亚洲人≥27），9 项患者健康问卷得分≥10），纳入研究。
干预措施
为期 12 个月的干预措施整合了行为减重计划和解决问题疗法，同时按需提供抗抑郁药物治疗抑郁。
主要观察指标
预先设定的次要结局包括健康相关生活质量（SF-8 健康调查）、肥胖相关生活质量（肥胖相关问题量表）、睡眠障碍和睡眠相关损害（患者报告结局测量信息系统）以及功能障碍（Sheehan 残疾量表），在基线和 6 个月及 12 个月时进行评估。
结果
与对照组相比，接受干预的患者在肥胖相关问题、心理健康相关生活质量、睡眠障碍、睡眠相关损害和功能障碍等方面在 6 个月时显著改善，但在 12 个月时无显著改善。肥胖相关问题（β=0.01，95%置信区间=0.01，0.02）和睡眠障碍（β= -0.02，95%置信区间= -0.04，0）的改善与 BMI 降低相关。SF-8 健康调查的身体（β= -0.01，95%置信区间= -0.01，0）和心理健康组成部分（β= -0.02，95%置信区间= -0.03，-0.02）以及睡眠障碍（β=0.01，95%置信区间=0.01，0.02）和睡眠相关损害（β=0.01，95%置信区间=0，0.01）的改善与抑郁症状减少相关。
结论
先前已证实可改善体重和抑郁症状的肥胖合并抑郁的综合协作式护理干预，可能还会在 6 个月内为生活质量和心理社会功能带来获益。
试验注册
本研究在 clinicaltrials.gov 注册，编号为 NCT02246413。
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