Division of Primary Care and Population Health, Department of Medicine, Stanford University, Portola Valley, CA, USA.
Department of Medicine, Qualitative Sciences Unit, School of Medicine, Stanford University, Palo Alto, CA, USA.
J Integr Complement Med. 2022 Sep;28(9):721-728. doi: 10.1089/jicm.2021.0329. Epub 2022 Jun 7.
The prevalence of anxiety disorders in primary care is 20%, with 41% of these patients reporting no current treatment. Patients with anxiety are also more likely to have comorbidities with other medical and/or psychiatric conditions, increasing medical costs. Integrating mindfulness-based interventions (MBIs) into a group medical visit (GMV) format has been successfully used to manage pain, but limited literature is available on the effectiveness of these visit formats for patients with stress and anxiety. Ninety-two adult patients with self-reported stress and/or anxiety were recruited from three university outpatient primary care clinics between 2016 and 2019. Participants attended at least 4 of 6 weekly GMVs focused on MBIs. Change in heart rate, blood pressure, Generalized Anxiety Disorder-7 (GAD-7) score, and 9 item Patient Health Questionnaire (PHQ-9) score from the first to last visit were evaluated using mixed effect linear regression models. Both GAD-7 (estimated change: -5.1; 95% confidence interval [CI]: -6.4 to -3.7) and PHQ-9 (estimated change: -3.3; 95% CI: -4.3 to -2.2) scores significantly decreased from the first to last visit. These reductions were independent of age, sex, and number of visits attended. No significant changes in heart rate or blood pressure were found. Significant reductions in anxiety and depression in primary care patients were observed after a 6-week standardized mindfulness based GMV. Intergroup variability was not significant indicating that the intervention is reproducible over time and across providers. Future randomized controlled trials with appropriate controls will better evaluate which components of the intervention account for findings.
在初级保健中，焦虑症的患病率为 20%，其中 41%的患者报告目前未接受治疗。患有焦虑症的患者也更有可能同时患有其他医学和/或精神疾病，这会增加医疗费用。将基于正念的干预措施 (MBIs) 整合到小组医疗访问 (GMV) 中已成功用于治疗疼痛，但关于这些访问格式对压力和焦虑患者的有效性的文献有限。 2016 年至 2019 年间，从三所大学门诊初级保健诊所招募了 92 名自我报告有压力和/或焦虑的成年患者。参与者参加了至少 6 次每周 GMV 中的 4 次，重点是 MBIs。使用混合效应线性回归模型评估从第一次到最后一次就诊时的心率、血压、广泛性焦虑症 7 项量表 (GAD-7) 评分和 9 项患者健康问卷 (PHQ-9) 评分的变化。从第一次到最后一次就诊时，GAD-7（估计变化：-5.1；95%置信区间 [CI]：-6.4 至 -3.7）和 PHQ-9（估计变化：-3.3；95% CI：-4.3 至 -2.2）评分均显著降低。这些减少与年龄、性别和就诊次数无关。心率或血压没有明显变化。在经过 6 周标准化的基于正念的 GMV 后，初级保健患者的焦虑和抑郁显著减轻。组间变异性不显著，表明干预措施具有时间和提供者的可重复性。未来的随机对照试验将更好地评估干预措施的哪些组成部分可以解释研究结果。
