Medical School, University of Talca, Talca, Chile
Medical School, University of Talca, Talca, Chile.
Ann Fam Med. 2024 Nov-Dec;22(6):467-475. doi: 10.1370/afm.3184.
The purpose of this study was to evaluate the effectiveness of collaborative trauma-informed care (CTIC) for treating depression in primary care in Chile.
From August 2021 through June 2023, 16 primary care teams in the Maule Region of Chile, were randomly assigned to either the CTIC or usual treatment (UT) group. At baseline, 3 months, and 6 months, 115 patients in the CTIC group, and 99 in the UT group, were blindly evaluated. The primary outcome was reduction in depressive symptoms. Secondary outcomes included improvement in anxiety symptoms, interpersonal and social functioning, emotional regulation, and adherence. Intention-to-treat data analysis, using analysis of covariance was conducted.
There were 214 patients recruited; 85% were women, and 61% had 4 or more adverse childhood experiences. At 6 months, depressive symptoms declined significantly in the CTIC arm relative to UT (adjusted mean difference [AMD]= -3.09, 95% CI, -4.94 to -1.23; d = -0.46, 95% CI,-0.73 to -0.18; = .001). Anxiety symptoms exhibited a trend toward improvement in the CTIC vs UT group (AMD = -1.50, 95% CI, -3.03 to 0.31; = .055). No significant differences were observed in other secondary outcomes, except for adherence, which was significantly higher in the CTIC vs UT groups (AMD = 2.59, 95% CI, 1.80-4.99; = .035).
The CTIC approach demonstrated superior outcomes in treating depression and improving adherence compared with UT. Moreover, the observed trends in anxiety improvement warrant further exploration in future research with a larger sample size. It is necessary to assess the effectiveness of this approach in treating more complex, difficult-to-treat forms of depression.
本研究旨在评估协同创伤知情照护（CTIC）在智利初级保健中治疗抑郁症的有效性。
2021 年 8 月至 2023 年 6 月，智利马乌莱地区的 16 个初级保健团队被随机分配至 CTIC 组或常规治疗（UT）组。在基线、3 个月和 6 个月时，对 CTIC 组的 115 名患者和 UT 组的 99 名患者进行盲法评估。主要结局是抑郁症状的减轻。次要结局包括焦虑症状、人际和社会功能、情绪调节和依从性的改善。采用协方差分析进行意向治疗数据分析。
共招募了 214 名患者；85%为女性，61%有 4 次或更多不良童年经历。在 6 个月时，CTIC 组的抑郁症状较 UT 组显著下降（调整平均差异 [AMD]=-3.09，95%置信区间，-4.94 至 -1.23；d=-0.46，95%置信区间，-0.73 至 -0.18； =.001）。焦虑症状在 CTIC 组相对于 UT 组呈改善趋势（AMD=-1.50，95%置信区间，-3.03 至 0.31； =.055）。除了依从性，其他次要结局均未见显著差异，CTIC 组显著高于 UT 组（AMD=2.59，95%置信区间，1.80-4.99； =.035）。
与 UT 相比，CTIC 方法在治疗抑郁症和提高依从性方面显示出更好的结果。此外，焦虑改善的观察趋势需要在未来更大样本量的研究中进一步探讨。有必要评估这种方法在治疗更复杂、更难治疗的抑郁症形式方面的有效性。
