Sangath, House no. 451 (168), Socorro Village, Bardez-Goa, Goa, 403501, India; Charité - Universitätsmedizin, Charitéplatz 1, Berlin, 10117, Germany.
London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
Drug Alcohol Depend. 2021 Oct 1;227:108961. doi: 10.1016/j.drugalcdep.2021.108961. Epub 2021 Aug 11.
We investigated the feasibility, acceptability, safety, and preliminary effectiveness of the Counselling for Alcohol Problems (CAP) psychological intervention delivered by non-specialist health workers (NSHW) to participants with alcohol use disorder (AUD) and comorbid depression in primary care.
We used data from a single blind randomised controlled trial conducted in ten primary health care centres in Goa, India. Adult male harmful or dependent drinkers with or without depression were randomized (1:1) to receive either CAP & enhanced usual care (EUC) or EUC only. Process indicators such as the number of completed counselling sessions were assessed and compared between comorbid and non-comorbid participants. Remission from AUD and depression along with abstinence were measured at 3 and 12 months post randomisation. Analyses were on an intention-to-treat basis, employing multivariable regression analyses.
271 participants had symptoms of comorbid depression; 241 did not. Both groups completed a similar number of counselling sessions (adjusted Mean Difference 0.05, 95 %CI -0.24-0.34;p = 0.72). Among comorbid participants, CAP did not lead to more frequent adverse events compared to EUC only (adjusted Odds Ratio [aOR] 0.84, 0.43-1.64;p = 0.62), and there was no evidence for an effect of CAP on remission from AUD or depression at 3 months (aOR 1.51, 0.84-2.74;p = 0.17 and aOR 0.74, 0.43-1.27;p = 0.28) and 12 months follow-up, respectively (aOR 1.69, 0.96-3.01;p = 0.08 and aOR 1.08, 0.62-1.87;p = 0.79).
Brief therapies like CAP can be safely delivered by NSHWs to patients with comorbid AUD and depression, but their effectiveness may be limited and requires further investigation.
我们研究了由非专业卫生工作者（NSHW）向初级保健中患有酒精使用障碍（AUD）和共病抑郁症的参与者提供咨询以解决酒精问题（CAP）的心理干预的可行性、可接受性、安全性和初步效果。
我们使用了在印度果阿的 10 个初级保健中心进行的一项单盲随机对照试验的数据。成年男性有害或依赖饮酒者，无论是否患有抑郁症，均按 1:1 随机分为接受 CAP 和增强常规护理（EUC）或仅接受 EUC。评估了共病和非共病参与者之间完成的咨询次数等过程指标，并进行了比较。在随机分组后 3 个月和 12 个月时测量 AUD 和抑郁症的缓解以及戒酒情况。分析基于意向治疗原则，采用多变量回归分析。
271 名参与者有共病抑郁症的症状；241 名没有。两组完成的咨询次数相似（调整后的平均差异 0.05，95%CI-0.24-0.34；p=0.72）。在共病参与者中，与仅接受 EUC 相比，CAP 并未导致更频繁的不良事件（调整后的优势比[aOR]0.84，0.43-1.64；p=0.62），并且 CAP 对 AUD 或抑郁症缓解的影响在 3 个月（aOR 1.51，0.84-2.74；p=0.17）和 12 个月随访时也没有证据（aOR 1.69，0.96-3.01；p=0.08 和 aOR 1.08，0.62-1.87；p=0.79）。
像 CAP 这样的简短疗法可以由 NSHW 安全地提供给患有 AUD 和共病抑郁症的患者，但它们的效果可能有限，需要进一步研究。
