Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Department of Family and community Medicine, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Department of Pharmacology & Toxicology, University of Toronto, Toronto, Ontario, Canada; Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
J Subst Use Addict Treat. 2024 Feb;157:209207. doi: 10.1016/j.josat.2023.209207. Epub 2023 Nov 7.
Virtual collaborative care for people with comorbid depression and at-risk drinking lacks strong evidence. Our aim was to assess the impact of 12 months of telephone collaborative care (tCC) versus enhanced usual care (eUC) on depression and drinking.
We performed a secondary analysis of the Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study (PARTNERs), a blinded randomized controlled trial. We examined 144 participants with comorbid depression and at-risk drinking, of which 129 were from the original sample whose data have been published, and 15 were studied since the original report had been published. PARTNERs compared eUC consisting of usual care plus assessment of symptoms at baseline, and 4, 8, and 12 months later vs. tCC consisting of eUC plus telephone-based coaching and symptom monitoring provided by a lay mental health technician to patients supervised by a psychiatrist. The study assessed depression response and remission using logistic regression; we assessed trajectory of drinking using Generalized-estimating equations (GEE). Baseline factors associated with likelihood of not exceeding number of drinks at 12 months were identified using decision trees.
tCC produced a faster decline in the number of drinks than eUC (Wald Χ = 9.47, p = 0.02). However, drinking and depression outcomes did not differ significantly between the two groups at the end of treatment. Higher alcohol consumption at baseline (≥18 standard drinks per week in the tCC group and ≥11 standard drinks per week in the eUC group) was associated with a higher likelihood of having at-risk drinking after 12 months of treatment.
Our findings suggest that, compared to eUC, tCC may accelerate drinking reductions in patients with comorbid depression and at-risk drinking. Both treatments were equally effective at the end of treatment for both depression and drinking outcomes.
针对共病抑郁和有风险饮酒的人群，虚拟协作式护理缺乏有力的证据。本研究旨在评估为期 12 个月的电话协作护理（tCC）与增强的常规护理（eUC）对抑郁和饮酒的影响。
我们对原发性护理评估和研究电话干预神经精神状况的教育和资源研究（PARTNERs）进行了二次分析，这是一项盲法随机对照试验。我们研究了 144 名共病抑郁和有风险饮酒的患者，其中 129 名来自原始样本的数据已发表，15 名是自原始报告发表后研究的。PARTNERs 将 eUC 与常规护理以及在基线、4、8 和 12 个月后对症状的评估进行比较，而 tCC 则由一名非专业的心理健康技术人员通过电话为患者提供基于 eUC 的辅导和症状监测，由精神病医生对患者进行监督。该研究使用逻辑回归评估抑郁反应和缓解情况；我们使用广义估计方程（GEE）评估饮酒轨迹。使用决策树确定与 12 个月内不超过饮酒量相关的基线因素。
tCC 比 eUC 导致饮酒量下降更快（Wald Χ = 9.47，p = 0.02）。然而，在治疗结束时，两组之间的饮酒和抑郁结果没有显著差异。较高的基线饮酒量（在 tCC 组中≥18 标准饮料/周，在 eUC 组中≥11 标准饮料/周）与治疗 12 个月后有风险饮酒的可能性更高相关。
与 eUC 相比，tCC 可能会加速共病抑郁和有风险饮酒患者的饮酒减少。两种治疗方法在治疗结束时对抑郁和饮酒结果都同样有效。
