Bell Georgia, Baou Celine El, Saunders Rob, Buckman Joshua E J, Charlesworth Georgina, Richards Marcus, Brown Barbara, Nurock Shirley, Michael Stuart, Ware Paul, Aguirre Elisa, Rio Miguel, Cooper Claudia, Pilling Stephen, John Amber, Stott Joshua
Adapt Lab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK.
Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK.
EClinicalMedicine. 2022 Oct 14;52:101692. doi: 10.1016/j.eclinm.2022.101692. eCollection 2022 Oct.
Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia.
National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration).
Symptoms of depression ((1548)=31·05, <·001) and anxiety ((1548)=30·31, <·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: =-0·83; anxiety: =-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], =·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], ·029) than a matched control sample without dementia.
Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes.
This work was supported by the Alzheimer's Society.
抑郁症和焦虑症在痴呆症患者（PLWD）中很常见且有害。目前尚不清楚常规提供的心理治疗是否有助于减轻PLWD的这些症状。本研究旨在调查在初级保健心理治疗服务中为PLWD提供的治疗过程中抑郁和焦虑症状的改善情况，并将结果与非痴呆症患者进行比较。
利用来自英格兰改善心理治疗服务可及性（IAPT）的全国数据，与医院 Episode 统计数据、心理健康服务数据集和 HES-ONS 死亡率数据相链接，以识别出1549名在2012年至2019年期间在IAPT完成心理治疗课程的PLWD，以及一个倾向得分匹配的未确诊痴呆症的对照组。结果测量包括干预前后抑郁（PHQ-9）和焦虑（GAD-7）症状的变化以及治疗结果（可靠改善、康复、恶化）。
在心理治疗过程中，PLWD的抑郁症状（（1548）=31.05，<0.001）和焦虑症状（（1548）=30.31，<0.001）得到改善，效应量较大（抑郁：=-0.83；焦虑：=-0.80）。然而，与未患痴呆症的匹配对照组相比，PLWD可靠改善（OR = 0.75，95%CI[0.63,0.88]，p<0.001）或康复（OR = 0.75，95%CI[0.64,0.88]，=0.001）的可能性较小，但恶化（OR = 1.35，95%CI[1.03,1.78]，=0.029）的可能性更大。
心理治疗可能对患有抑郁症或焦虑症的PLWD有益，但目前不如对非痴呆症患者有效。需要更多研究来改善心理治疗的可及性，并了解这种差异以及如何调整治疗方法以进一步改善结果。
这项工作得到了阿尔茨海默病协会的支持。
