Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK.
J Affect Disord. 2024 Jan 15;345:70-77. doi: 10.1016/j.jad.2023.10.105. Epub 2023 Oct 19.
Despite the known health costs of persistent depression, there is no established service framework for the treatment of this disorder and a lack of long-term outcome data to inform commissioning. To address this gap, we report the long-term clinical effectiveness of a randomised controlled trial (RCT) testing a specialist, collaborative model of care for people with persistent moderate to severe unipolar depression.
A multicentre, pragmatic, single-blind, parallel-group randomised controlled trial comparing outcomes from a Specialist Depression Service (SDS) offering collaborative treatment with cognitive behavioural therapy (CBT) and pharmacotherapy for 12 months with treatment as usual (TAU) for persistent, moderate-severe depression in UK secondary care. Participants were initially assessed at baseline, 3, 6, 9, 12, and 18 months, with primary endpoints (17-item Hamilton Depression Rating Scale [HDRS17], and a Global Assessment of Functioning [GAF]) reported elsewhere (Morriss et al., 2016). Additional long-term, post-treatment, follow-up was made at 24 and 36 months with outcomes presented here.
gov (NCT01047124) and ISRCTN registration (ISRCTN 10963342).
At 24 months there remained a statistically significant between-group difference in HDRS-2.69 (-5.14, -0.23) and a non-significant improvement in GAF 2.85 (-1.23, 6.94), both favouring the SDS. Simple statistics are presented at 36 months, due to attrition, showing higher continued response and remission vs TAU across all measures.
Potential bias through loss to follow-up, particularly beyond 24 months.
Compared with standard secondary care, SDS management of persistent moderate-severe depression, produced long-term clinical benefits, sustained following treatment completion, suggesting a model for future specialist care.
尽管持续性抑郁症的已知健康成本，但目前还没有针对这种疾病的既定服务框架，也缺乏长期的结果数据来为委托提供信息。为了解决这一差距，我们报告了一项针对持续性中度至重度单相抑郁症患者的专门协作护理模式的随机对照试验（RCT）的长期临床效果。
一项多中心、实用、单盲、平行组随机对照试验，比较了为持续性、中度至重度抑郁的英国二级保健患者提供 12 个月的协作治疗（包括认知行为疗法（CBT）和药物治疗）的专科抑郁服务（SDS）与常规治疗（TAU）的结果。参与者最初在基线、3、6、9、12 和 18 个月时进行评估，主要终点（17 项汉密尔顿抑郁量表 [HDRS17] 和总体功能评估 [GAF]）已在其他地方报告（Morriss 等人，2016 年）。此处介绍的是在 24 个月和 36 个月进行的额外长期治疗后随访的结果。
gov（NCT01047124）和 ISRCTN 注册（ISRCTN 10963342）。
在 24 个月时，HDRS-2 的组间差异仍具有统计学意义（-5.14，-0.23），GAF 有非显著改善（-1.23，6.94），均有利于 SDS。由于失访，36 个月时仅呈现简单的统计数据，所有指标均显示 SDS 组的持续反应和缓解率更高。
随访期间，尤其是在 24 个月之后，存在潜在的偏倚。
与标准二级护理相比，SDS 管理持续性中度至重度抑郁症，在治疗完成后仍能产生长期的临床获益，表明该模式可为未来的专科护理提供参考。
