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针对抑郁和有自杀倾向青少年的强化门诊项目的治疗结果

Treatment Outcomes of an Adolescent Intensive Outpatient Program for Depressed and Suicidal Youth.

作者信息

Bero Kelsey M, Teresi Giana I, Porta Giovanna, Poling Kimberly, Brent David A, Goldstein Tina R

机构信息

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

University of Pittsburgh, Pittsburgh, Pennsylvania.

出版信息

JAACAP Open. 2024 Dec 11;3(3):576-588. doi: 10.1016/j.jaacop.2024.10.006. eCollection 2025 Sep.

Abstract

OBJECTIVE

Intensive outpatient programs (IOPs) provide an intermediate level of care for high-risk youth and were required to rapidly pivot to telehealth services amid the COVID-19 pandemic. This article aimed to compare symptom outcomes among adolescents treated in IOPs before vs during the pandemic and during the latter period to examine outcomes among adolescents who attended in-person vs via telehealth IOPs.

METHOD

Depressed adolescents recommended for IOPs between December 2014 and April 2022 (N = 1,152) completed validated self-reports throughout treatment. Patients treated during the pandemic completed treatment in person, via telehealth, or a combination of both. Mixed-effects models were used to examine changes in symptoms over time in treatment.

RESULTS

Compared with pre-pandemic patients (n = 828), adolescents who presented for treatment after the pandemic onset (n = 324) reported increased depression, anxiety, and nonsuicidal self-injury (s ≤. 006) at intake. Adolescents treated in IOPs (n = 855) demonstrated significant improvement over each week in treatment (s < .001) across measures of depression ( = -0.79, 95% CI [-0.88, -0.71]), suicidal ideation and behavior (odds ratio = 0.59, 95% CI [0.55, 0.62]), and nonsuicidal self-injury (odds ratio = 0.51, 95% CI [0.46, 0.56]). Significant interactions between time and patient cohort indicated that the slopes of improvement for all outcomes were steeper during the pandemic (s < .001). There were no differences in improvement of depression, suicidal thoughts and behaviors, or nonsuicidal self-injury for in-person vs telehealth treatment during the pandemic.

CONCLUSION

These findings indicate similar treatment response to both IOP treatment modalities for suicidal adolescents. Future research should discern factors leading to faster response after the pandemic onset.

摘要

目的

强化门诊项目(IOPs)为高危青少年提供中等程度的护理,并且在新冠疫情期间需要迅速转向远程医疗服务。本文旨在比较疫情之前与疫情期间在IOPs接受治疗的青少年的症状结果,以及在后期比较亲自参加IOPs与通过远程医疗参加IOPs的青少年的结果。

方法

2014年12月至2022年4月期间被推荐参加IOPs的抑郁青少年(N = 1152)在整个治疗过程中完成了经过验证的自我报告。在疫情期间接受治疗的患者通过亲自、远程医疗或两者结合的方式完成治疗。混合效应模型用于检查治疗过程中症状随时间的变化。

结果

与疫情前的患者(n = 828)相比,疫情开始后前来治疗的青少年(n = 324)在入院时报告的抑郁、焦虑和非自杀性自伤情况有所增加(s≤0.006)。在IOPs接受治疗的青少年(n = 855)在治疗的每一周中,在抑郁(β = -0.79,95%CI [-0.88,-0.71])、自杀意念和行为(优势比 = 0.59,95%CI [0.55,0.62])以及非自杀性自伤(优势比 = 0.51,95%CI [0.46,0.56])的各项测量指标上均显示出显著改善(s < 0.001)。时间与患者队列之间的显著交互作用表明,在疫情期间所有结果的改善斜率都更陡(s < 0.001)。在疫情期间,亲自治疗与远程医疗治疗在抑郁、自杀想法和行为或非自杀性自伤的改善方面没有差异。

结论

这些发现表明,两种IOP治疗方式对有自杀倾向的青少年的治疗反应相似。未来的研究应该识别出导致疫情开始后反应更快的因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/142e/12414322/393411d987b1/gr1.jpg

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