采用阶梯式照护框架，将针对老年抑郁和焦虑患者的循证心理干预措施翻译成公共和私人心理健康服务机构的语言：研究方案。

Translating evidence-based psychological interventions for older adults with depression and anxiety into public and private mental health settings using a stepped care framework: Study protocol.

机构信息

Centre for Emotional Health, Department of Psychology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2109, Australia; Centre for Ageing, Cognition and Wellbeing, Faculty of Medicine, Human and Health Sciences, Macquarie University, Sydney 2109, Australia.

出版信息

Contemp Clin Trials. 2021 May;104:106360. doi: 10.1016/j.cct.2021.106360. Epub 2021 Mar 22.

DOI:10.1016/j.cct.2021.106360

PMID:33766760

Abstract

BACKGROUND

With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system.

DESIGN

A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention.

DISCUSSION

This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings.

TRAIL REGISTRATION

Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850).

摘要

背景

随着全球老年人口数量的预期增加，为老年人群提供分级心理护理治疗抑郁和焦虑，可能会提高个体患者和医疗体系的治疗效果和配置效率。

设计

本研究将开展一项多站点实用随机对照试验，评估针对老年人群的分级照护模式治疗抑郁和焦虑的临床疗效和成本效益，与常规治疗（TAU）相比。将从澳大利亚的 6 家心理健康服务机构招募符合条件的（n=666）有临床显著焦虑和/或抑郁症状的参与者，并在这些机构中进行治疗。干预组将完成一个低强度认知行为疗法（CBT）项目：使用互联网或在家工作的书籍，辅以简短的治疗师电话（第 1 步）。在第 1 步之后，如果需要，将提供更高强度的面对面 CBT（第 2 步）。将采用意向治疗分析来评估主要结局（例如，临床医生评定的症状严重程度变化）和次要结局（例如，自我报告的症状严重程度、健康相关生活质量和服务利用成本）的变化。将进行经济评估，采用成本效用分析得出分级照护干预的增量成本效益比。