Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
Nat Med. 2024 Apr;30(4):1127-1133. doi: 10.1038/s41591-024-02864-4. Epub 2024 Mar 14.
Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving depressive symptomatology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥ 10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation (n = 298) or a single message (n = 305). No health professional support was offered. The primary outcome was improvement from depressive symptomatology (PHQ-9 < 10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07-2.29; P = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive symptomatology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC ( RBR-4c94dtn ).
在资源匮乏的环境中,迫切需要能够有效治疗老年人抑郁症的可扩展解决方案。PRODIGITAL-D 是一项实用、单盲、双臂、个体随机对照试验,评估了一种移动信息心理社会干预措施在改善巴西瓜鲁柳斯社会经济贫困地区老年人抑郁症状方面的有效性。在 24 个初级保健诊所登记并伴有抑郁症状(9 项患者健康问卷 (PHQ-9) 得分≥10 分)的老年人(年龄≥ 60 岁)接受了基于心理教育和行为激活的为期 6 周的 Viva Vida 干预(n = 298)或单一信息(n = 305)。没有提供任何健康专业支持。主要结局是 3 个月时抑郁症状(PHQ-9<10)改善。603 名入组参与者(平均年龄 65.1 岁;451 名(74.8%)女性)中,527 名(87.4%)完成了随访评估。在干预组中,257 名参与者中有 109 名(42.4%)的抑郁症状得到改善,而 270 名参与者中有 87 名(32.2%)的参与者在对照组中(调整后的优势比=1.57;95%置信区间=1.07-2.29;P=0.019)。没有观察到与试验参与相关的严重不良事件。这些结果表明,数字信息心理社会干预在短期内改善抑郁症状方面是有用的,这种干预有可能被整合到初级保健计划中,用于治疗患有抑郁症的老年人。巴西临床试验注册处注册:ReBEC(RBR-4c94dtn)。
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