Research Institute, Nicklaus Children's Research Institute, Miami, Florida.
School Psychology, University of Lancashire, Preston, UK.
Pediatr Pulmonol. 2020 Nov;55(11):2995-3004. doi: 10.1002/ppul.24949. Epub 2020 Jul 21.
A large-scale epidemiological study of 6088 individuals with cystic fibrosis (CF) and 4102 caregivers in nine countries documented elevated symptoms of depression and anxiety, leading to international guidelines for annual screening and follow-up. To facilitate national implementation, 84 CF programs funded a mental health coordinators (MHC). Implementation was evaluated after 1 year using the consolidated framework for implementation research (CFIR) to identify facilitators and barriers.
A 45-item internet survey was developed to assess relevant CFIR implementation steps. Surveys were completed in 2016. It assessed five domains tailored to study aims: (a) Intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of individuals, and (e) process of implementation.
Response rate was 88%, with pediatric and adult programs equally represented. A majority of MHCs were social workers (54.1%) and psychologists (41.9%); 41% had joined the team in the past year. Facilitators across the five domains included universal uptake of screening tools, greater awareness and detection of psychological symptoms, reduced stigma, and positive feedback from patients and families. Barriers included limited staff time, space, and logistics.
This is the largest systematic effort to integrate mental health screening and treatment into the care of individuals with a serious, chronic illness and their caregivers. MHCs implementing screening, interpretation and follow-up reported positive results, and significant barriers. This national implementation effort demonstrated that depression and anxiety can be efficiently evaluated and treated in a complex, chronic disease. Future efforts include recommending the addition of screening scores to national CF Registries and examining their effects on health outcomes.
一项针对 6088 名囊性纤维化 (CF) 患者和 4102 名护理人员的大规模流行病学研究记录了抑郁和焦虑症状的升高，这导致了国际年度筛查和随访指南的制定。为了促进国家实施，84 个 CF 项目资助了心理健康协调员 (MHC)。使用实施研究综合框架 (CFIR) 对实施情况进行了 1 年评估，以确定促进因素和障碍。
开发了一个包含 45 个项目的互联网调查，以评估相关的 CFIR 实施步骤。调查于 2016 年完成。它评估了五个针对研究目的量身定制的领域：(a)干预措施特征，(b)外部环境，(c)内部环境，(d)个体特征，和 (e)实施过程。
回应率为 88%，儿科和成人项目的比例相当。大多数 MHC 是社会工作者 (54.1%)和心理学家 (41.9%)；41%的人在过去一年中加入了团队。五个领域的促进因素包括普遍采用筛查工具、提高对心理症状的认识和检测、减少污名化以及患者和家属的积极反馈。障碍包括员工时间、空间和后勤资源有限。
这是将心理健康筛查和治疗纳入个体严重慢性疾病及其护理人员护理的最大系统性努力。实施筛查、解释和随访的 MHC 报告了积极的结果和显著的障碍。这项国家实施工作表明，在复杂的慢性疾病中，可以有效地评估和治疗抑郁和焦虑。未来的努力包括建议将筛查分数添加到国家 CF 登记处，并研究其对健康结果的影响。
