Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN, USA.
Division of Integrated Behavioral Health, Mayo Clinic, Rochester, MN, USA; Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA.
J Affect Disord. 2021 Nov 1;294:745-752. doi: 10.1016/j.jad.2021.07.061. Epub 2021 Jul 19.
Individuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care.
Of the 1,302 participants with a primary depressive disorder referred by their primary care provider, 435 endorsed moderate to severe depression at baseline and engaged in at least one CBT session. A psychotherapy tracking database was used to collect relevant data, which included demographics, clinical characteristics, treatment outcomes, and CBT intervention use.
Participants with moderate to severe depression who participated in CBT reported a significant decrease in depression and anxiety symptoms at the end of treatment (p ≤ .001, d = 0.52-0.78). Rates of reliable change, response, and remission and types of CBT interventions used differed between major and persistent depressive disorders.
Multiple limitations must be noted, which are related to the naturalistic study design, inclusion and exclusion criteria, sample operationalization, symptomatic measurement, time-limited and focused assessment, data collection strategies, and psychological services. Together, these temper the conclusions that can be drawn.
Significant reductions in depression and anxiety symptoms were reported by participants with depressive disorders who engaged in short-term CBT within primary care. This study indicates that CBT can be implemented within primary care and suggests that primary care patients with depression can benefit from integrated psychological services, supporting population-based models of care.
患有抑郁症的个体经常在初级保健机构就诊并寻求治疗。在这种环境下，整合行为健康服务可以改善获得循证认知行为疗法（CBT）的机会。然而，关于初级保健中 CBT 治疗抑郁症的有效性的信息有限。
在由初级保健提供者转介的 1302 名患有原发性抑郁症的患者中，有 435 名患者在基线时出现中度至重度抑郁，并接受了至少一次 CBT 治疗。使用心理治疗追踪数据库收集相关数据，包括人口统计学、临床特征、治疗结果和 CBT 干预措施的使用情况。
接受 CBT 的中重度抑郁患者在治疗结束时报告抑郁和焦虑症状显著减轻（p≤.001，d=0.52-0.78）。主要和持续性抑郁障碍患者之间的可靠变化、反应和缓解率以及 CBT 干预措施的使用类型存在差异。
必须注意到多个局限性，这些局限性与自然主义研究设计、纳入和排除标准、样本操作化、症状测量、限时和重点评估、数据收集策略以及心理服务有关。这些因素共同影响了可以得出的结论。
参与初级保健中短期 CBT 的抑郁障碍患者报告抑郁和焦虑症状显著减轻。本研究表明 CBT 可以在初级保健中实施，并表明初级保健中患有抑郁症的患者可以从整合的心理服务中受益，支持基于人群的护理模式。
