Krijnen-de Bruin Esther, Muntingh Anna Dt, Bourguignon Evelien M, Hoogendoorn Adriaan, Maarsingh Otto R, van Balkom Anton Jlm, Batelaan Neeltje M, van Straten Annemieke, van Meijel Berno
Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, Netherlands.
Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.
JMIR Ment Health. 2022 Mar 16;9(3):e25441. doi: 10.2196/25441.
Given that relapse is common in patients in remission from anxiety and depressive disorders, relapse prevention is needed in the maintenance phase. Although existing psychological relapse prevention interventions have proven to be effective, they are not explicitly based on patients' preferences. Hence, we developed a blended relapse prevention program based on patients' preferences, which was delivered in primary care practices by mental health professionals (MHPs). This program comprises contact with MHPs, completion of core and optional online modules (including a relapse prevention plan), and keeping a mood and anxiety diary in which patients can monitor their symptoms.
The aims of this study were to provide insight into (1) usage intensity of the program (over time), (2) the course of symptoms during the 9 months of the study, and (3) the association between usage intensity and the course of symptoms.
The Guided E-healTh for RElapse prevention in Anxiety and Depression (GET READY) program was guided by 54 MHPs working in primary care practices. Patients in remission from anxiety and depressive disorders were included. Demographic and clinical characteristics, including anxiety and depressive symptoms, were collected via questionnaires at baseline and after 3, 6, and 9 months. Log data were collected to assess the usage intensity of the program.
A total of 113 patients participated in the study. Twenty-seven patients (23.9%) met the criteria for the minimal usage intensity measure. The core modules were used by ≥70% of the patients, while the optional modules were used by <40% of the patients. Usage decreased quickly over time. Anxiety and depressive symptoms remained stable across the total sample; a minority of 15% (12/79) of patients experienced a relapse in their anxiety symptoms, while 10% (8/79) experienced a relapse in their depressive symptoms. Generalized estimating equations analysis indicated a significant association between more frequent face-to-face contact with the MHPs and an increase in both anxiety symptoms (β=.84, 95% CI .39-1.29) and depressive symptoms (β=1.12, 95% CI 0.45-1.79). Diary entries and the number of completed modules were not significantly associated with the course of symptoms.
Although the core modules of the GET READY program were used by most of the patients and all patients saw an MHP at least once, usage decreased quickly over time. Most patients remained stable while participating in the study. The significant association between the frequency of contact and the course of symptoms most likely indicates that those who received more support had more symptoms, and thus, it is questionable whether the support offered by the program was sufficient to prevent these patients from relapsing.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-019-2034-6.
鉴于焦虑症和抑郁症缓解期患者复发情况常见，维持期需要预防复发。尽管现有的心理复发预防干预措施已被证明有效，但它们并非明确基于患者的偏好。因此，我们基于患者偏好开发了一个混合复发预防项目，该项目由心理健康专业人员（MHP）在初级保健机构实施。该项目包括与MHP接触、完成核心和可选在线模块（包括复发预防计划）以及记录情绪和焦虑日记，患者可在日记中监测自身症状。
本研究的目的是深入了解（1）该项目的使用强度（随时间变化），（2）研究9个月期间症状的变化过程，以及（3）使用强度与症状变化过程之间的关联。
焦虑和抑郁复发预防的引导式电子健康（GET READY）项目由在初级保健机构工作的54名MHP指导实施。纳入焦虑症和抑郁症缓解期患者。通过问卷调查在基线以及3、6和9个月后收集人口统计学和临床特征，包括焦虑和抑郁症状。收集日志数据以评估项目的使用强度。
共有113名患者参与研究。27名患者（23.9%）达到最低使用强度测量标准。≥70%的患者使用了核心模块，而<40%的患者使用了可选模块。随着时间推移，使用量迅速下降。整个样本中焦虑和抑郁症状保持稳定；15%（12/79）的少数患者焦虑症状复发，10%（8/79）的患者抑郁症状复发。广义估计方程分析表明，与MHP更频繁的面对面接触与焦虑症状增加（β = 0.84，95%CI 0.39 - 1.29）和抑郁症状增加（β = 1.12，95%CI 0.45 - 1.79）之间存在显著关联。日记记录和完成的模块数量与症状变化过程无显著关联。
尽管GET READY项目的核心模块被大多数患者使用，且所有患者至少与一名MHP见过一次面，但随着时间推移使用量迅速下降。大多数患者在参与研究期间保持稳定。接触频率与症状变化过程之间的显著关联很可能表明，获得更多支持的患者症状更多，因此，该项目提供的支持是否足以防止这些患者复发值得怀疑。
国际注册报告识别码（IRRID）：RR2 - 10.1186/s12888 - 019 - 2034 - 6。
