Department of Family Medicine, McGill University, Montreal, Quebec, Canada.
St. Mary's Hospital Department of Family Medicine, Montreal, Quebec, Canada.
PLoS One. 2024 Feb 15;19(2):e0297937. doi: 10.1371/journal.pone.0297937. eCollection 2024.
The COVID-19 pandemic has required family physicians to rapidly address increasing mental health problems with limited resources. Vulnerable home-based seniors with chronic physical conditions and commonly undermanaged symptoms of anxiety and depression were recruited in this pilot study to compare two brief self-care intervention strategies for the management of symptoms of depression and/or anxiety.
We conducted a pilot RCT to compare two tele-health strategies to address mental health symptoms either with 1) validated CBT self-care tools plus up to three telephone calls from a trained lay coach vs. 2) the CBT self-guided tools alone. The interventions were abbreviated from those previously trialed by our team, to enable their completion in 2 months. Objectives were to assess the feasibility of delivering the interventions during a pandemic (recruitment and retention); and assess the comparative acceptability of the interventions across the two groups (satisfaction and tool use); and estimate preliminary comparative effectiveness of the interventions on severity of depression and anxiety symptoms. Because we were interested in whether the interventions were acceptable to a wide range of older adults, no mental health screening for eligibility was performed.
90 eligible patients were randomized. 93% of study completers consulted the self-care tools and 84% of those in the coached arm received at least some coaching support. Satisfaction scores were high among participants in both groups. No difference in depression and anxiety outcomes between the coached and non-coached participants was observed, but coaching was found to have a significant effect on participants' use and perceived helpfulness of the tools.
Both interventions were feasible and acceptable to patients. Trained lay coaching increased patients' engagement with the tools. Self-care tools offer a low cost and acceptable remote activity that can be targeted to those with immediate needs. While effectiveness results were inconclusive, this may be due to the lack of eligibility screening for mental health symptoms, abbreviated toolkit, and fewer coaching sessions than those used in our previous effective interventions.
ClinicalTrials.gov Identifier: NCT0460937.
COVID-19 大流行要求家庭医生利用有限的资源，迅速解决不断增加的心理健康问题。本试点研究招募了脆弱的、以家庭为基础的、患有慢性躯体疾病且通常未得到充分管理的焦虑和抑郁症状的老年人，比较了两种用于管理抑郁和/或焦虑症状的简短自我护理干预策略。
我们进行了一项试点 RCT，比较了两种远程医疗策略，一种是使用经过验证的认知行为疗法（CBT）自我护理工具，外加由经过培训的非专业教练进行最多三次电话随访，另一种是单独使用 CBT 自我指导工具。干预措施从我们团队之前试用过的措施中进行了简化，以便在两个月内完成。目的是评估在大流行期间（招募和保留）实施干预措施的可行性；评估两组之间干预措施的可接受性（满意度和工具使用）；并初步评估干预措施对抑郁和焦虑症状严重程度的影响。由于我们有兴趣了解这些干预措施是否被广泛的老年人所接受，因此没有进行任何心理健康筛查来确定合格人选。
90 名符合条件的患者被随机分配。93%的研究完成者咨询了自我护理工具，84%的教练组参与者接受了至少一些教练支持。两组参与者的满意度评分都很高。在接受教练和未接受教练的参与者之间，抑郁和焦虑结果没有差异，但教练对参与者使用和感知工具的有用性有显著影响。
两种干预措施对患者来说都是可行和可接受的。经过培训的非专业教练增加了患者对工具的使用。自我护理工具提供了一种低成本且可接受的远程活动，可以针对那些有迫切需求的人进行。虽然有效性结果不确定，但这可能是由于缺乏对心理健康症状的资格筛查、简化的工具包以及比我们之前有效的干预措施少的教练课程所致。
ClinicalTrials.gov 标识符：NCT0460937。
