Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial.
Comparison of behavioural activation with guided self-help for treatment of depression in adults with intellectual disabilities: a randomised controlled trial.
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DOI：
10.1016/s2215-0366(17)30426-1
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Melville C
中科院分区：
文献类型：
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作者：
Jahoda A;Hastings R;Hatton C;Cooper SA;Dagnan D;Zhang R;McConnachie A;McMeekin N;Appleton K;Jones R;Scott K;Fulton L;Knight R;Knowles D;Williams C;Briggs A;MacMahon K;Lynn H;Smith I;Thomas G;Melville C
心理治疗是抑郁症的一线干预措施，但许多智障成年人无法获得现有的服务。我们调查了智力残疾和抑郁症患者的行为激活干预（BeatIt）的临床和成本效益。BeatIt与指导性自助干预（StepUp）进行了比较。我们进行了一项多中心、单盲、随机、对照试验，并在随机化后4个月和12个月进行随访。参与者年龄在18岁或以上，有轻度至中度智力残疾和临床上显著的抑郁症，从英国的健康和社会护理服务招募。主要结局是12个月时学习障碍患者的格拉斯哥抑郁量表（GDS-LD）评分。在意向治疗的基础上进行分析。本试验已在ISCRTN注册，编号为ISRCTN 09753005。在2013年8月8日至2015年9月1日期间，161名参与者被随机分配（84名参加BeatIt; 77名参加StepUp）; 141名（88%）参与者完成了试验。基于12个月时的GDS-LD评分，未发现BeatIt和StepUp的影响存在组间差异（BeatIt组为12.03 [SD 7.99] GDS-LD分，StepUp组为12.43 [SD 7.64] GDS-LD分;平均差异为0.26 GDS-LD分[95% CI − 2.18至2.70]; p= 0.833）。12个月时，两组GDS-LD评分均出现组内改善（BeatIt，平均变化-4.2 GDS-LD点[95%CI-6.0至-2.4]，p<0.0001; StepUp，平均变化-4.5 GDS-LD点[-6统计2至-2.7]，p<0.0001），效应量较大（BeatIt，0.590 [95% CI 0.337 - 0.844]; StepUp，0.627 [0.380 - 0.873]）。BeatIt与StepUp相比并不具有成本效益，尽管经济分析表明存在很大的不确定性。治疗费用仅占参与者总支持费用的3.6 - 6.8%。未报告治疗相关或试验相关不良事件。据我们所知，这项研究是第一项大型随机对照试验，评估了对智力残疾和精神健康问题患者的个体心理干预。这些发现表明，没有证据表明BeatIt比StepUp更有效;两者都是积极和潜在有效的干预措施。国立卫生研究院。
Psychological therapies are first-line interventions for depression, but existing provision is not accessible for many adults with intellectual disabilities. We investigated the clinical and cost-effectiveness of a behavioural activation intervention (BeatIt) for people with intellectual disabilities and depression. BeatIt was compared with a guided self-help intervention (StepUp). We did a multicentre, single-blind, randomised, controlled trial with follow-up at 4 months and 12 months after randomisation. Participants aged 18 years or older, with mild to moderate intellectual disabilities and clinically significant depression were recruited from health and social care services in the UK. The primary outcome was the Glasgow Depression Scale for people with a Learning Disability (GDS-LD) score at 12 months. Analyses were done on an intention-to-treat basis. This trial is registered with ISCRTN, number ISRCTN09753005. Between Aug 8, 2013, and Sept 1, 2015, 161 participants were randomly assigned (84 to BeatIt; 77 to StepUp); 141 (88%) participants completed the trial. No group differences were found in the effects of BeatIt and StepUp based on GDS-LD scores at 12 months (12·03 [SD 7·99] GDS-LD points for BeatIt vs 12·43 [SD 7·64] GDS-LD points for StepUp; mean difference 0·26 GDS-LD points [95% CI −2·18 to 2·70]; p=0·833). Within-group improvements in GDS-LD scores occurred in both groups at 12 months (BeatIt, mean change −4·2 GDS-LD points [95% CI −6·0 to −2·4], p<0·0001; StepUp, mean change −4·5 GDS-LD points [–6·2 to −2·7], p<0·0001), with large effect sizes (BeatIt, 0·590 [95% CI 0·337–0·844]; StepUp, 0·627 [0·380–0·873]). BeatIt was not cost-effective when compared with StepUp, although the economic analyses indicated substantial uncertainty. Treatment costs were only approximately 3·6–6·8% of participants' total support costs. No treatment-related or trial-related adverse events were reported. This study is, to our knowledge, the first large randomised controlled trial assessing individual psychological interventions for people with intellectual disabilities and mental health problems. These findings show that there is no evidence that BeatIt is more effective than StepUp; both are active and potentially effective interventions. National Institute for Health Research.