Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care Patients A Randomized Trial
Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care Patients A Randomized Trial
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DOI：
10.1001/jama.2012.5588
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发表时间：
2012-06-06
影响因子：
120.7
通讯作者：
Siddique, Juned
中科院分区：
文献类型：
--
作者：
Mohr, David C.;Ho, Joyce;Siddique, Juned
背景初级保健是治疗抑郁症最常见的场所。大多数抑郁症患者更喜欢心理治疗而不是抗抑郁药物，但人们认为获得障碍会阻碍治疗的参与和完成。电话作为一种克服准入障碍的治疗传递媒介已被研究，但与面对面治疗传递相比，其功效知之甚少。 目的 检验电话认知行为疗法 (T-CBT) 是否能减少损耗，并且在治疗初级保健患者的抑郁症方面是否不逊色于面对面 CBT。 设计、设置和参与者 一项随机对照试验，纳入 325 名芝加哥地区初级保健重度抑郁症患者，招募时间为 2007 年 11 月至 12 月2010.干预措施 18 次 T-CBT 或面对面 CBT。主要结果指标 主要结果是治疗后（第 18 周）的自然减员（完成与未完成）。次要结局包括使用汉密尔顿抑郁评定量表 (Ham-D) 进行的隐面访调员评定的抑郁症以及使用患者健康问卷 9 (PHQ-9) 进行自我报告的抑郁症。 结果 与面对面 CBT (n=53; 32.7%; P=.02) 相比，停止 T-CBT 的参与者明显较少 (n=34; 20.9%)。在两种治疗中，患者的抑郁症均表现出显着改善（P
Context Primary care is the most common site for the treatment of depression. Most depressed patients prefer psychotherapy over antidepressant medications, but access barriers are believed to prevent engagement in and completion of treatment. The telephone has been investigated as a treatment delivery medium to overcome access barriers, but little is known about its efficacy compared with face-to-face treatment delivery.Objective To examine whether telephone-administered cognitive behavioral therapy (T-CBT) reduces attrition and is not inferior to face-to-face CBT in treating depression among primary care patients.Design, Setting, and Participants A randomized controlled trial of 325 Chicago-area primary care patients with major depressive disorder, recruited from November 2007 to December 2010.Interventions Eighteen sessions of T-CBT or face-to-face CBT.Main Outcome Measures The primary outcome was attrition (completion vs non-completion) at posttreatment (week 18). Secondary outcomes included masked interviewer-rated depression with the Hamilton Depression Rating Scale (Ham-D) and self-reported depression with the Patient Health Questionnaire-9 (PHQ-9).Results Significantly fewer participants discontinued T-CBT (n=34; 20.9%) compared with face-to-face CBT (n=53; 32.7%; P=.02). Patients showed significant improvement in depression across both treatments (P