Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
Department of Family and Preventive Medicine, School of Medicine, Emory University, 1518 Clifton Rd, Atlanta 30322, USA.
Gen Hosp Psychiatry. 2022 Jan-Feb;74:39-45. doi: 10.1016/j.genhosppsych.2021.11.003. Epub 2021 Nov 27.
We assessed the impact of a collaborative care intervention on anxiety symptoms among participants in India with comorbid depression, poorly controlled diabetes, and moderate to severe anxiety symptoms.
We analyzed data from a randomized controlled trial conducted at four diabetes clinics in India. Participants received either collaborative care or usual care. We included only participants who scored ⩾10 on the Generalized Anxiety Disorder-7 (GAD-7) at baseline. We estimated the effect of the intervention on clinically significant reduction in anxiety symptoms; we considered several potential baseline moderators and mediation by anti-depressant use.
One hundred and seventy-two participants scored 10 or above on the GAD-7 at baseline. Collaborative care participants were more likely than control participants to achieve a clinically significant reduction in anxiety symptoms at 6 and 12 months (65.7% vs. 41.4% at 12 months, p = 0.002); these differences were not sustained at 18 or 24 months. There was little evidence of moderation by participant characteristics at baseline, and effects were not mediated by anti-depressant use.
Collaborative care for the treatment of depression and type 2 diabetes can lead to clinically significant reductions in anxiety symptoms among patients with anxiety. Effects were notable during the active intervention period but not over the year post-intervention.
评估合作式护理干预对同时患有抑郁症、糖尿病控制不佳和中重度焦虑症状的印度患者焦虑症状的影响。
我们分析了在印度 4 家糖尿病诊所进行的一项随机对照试验的数据。参与者接受合作式护理或常规护理。我们仅纳入基线时 7 项广泛性焦虑障碍量表（GAD-7）评分 ⩾10 的参与者。我们评估了干预对焦虑症状明显缓解的效果；我们考虑了一些潜在的基线调节因素和抗抑郁药使用的中介作用。
172 名基线时 GAD-7 评分 ⩾10 的参与者。与对照组相比，合作式护理组在 6 个月和 12 个月时更有可能实现焦虑症状的临床显著缓解（12 个月时为 65.7% vs. 41.4%，p=0.002）；这些差异在 18 个月或 24 个月时没有持续。基线时参与者特征的调节作用很小，抗抑郁药的使用也没有起到中介作用。
针对抑郁症和 2 型糖尿病的合作式护理可以显著减轻焦虑患者的焦虑症状。在积极干预期间效果显著，但在干预后一年效果不明显。
