Motivational Interviewing Improves Depression Outcome in Primary Care: A Cluster Randomized Trial
Motivational Interviewing Improves Depression Outcome in Primary Care: A Cluster Randomized Trial
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DOI：
10.1037/ccp0000124
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发表时间：
2016-11-01
影响因子：
5.9
通讯作者：
Emsermann, Caroline
中科院分区：
文献类型：
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作者：
Keeley, Robert D.;Brody, David S.;Emsermann, Caroline
目的：研究由初级保健提供者进行的动机访谈（MI）对新诊断的重度抑郁症低收入患者抑郁症状随时间推移的改善率和缓解率的影响。方法：10个护理团队被随机分配到MI与抑郁症的标准管理（MI-SMD; 4个团队，10个供应商，88例患者）或SMD单独（6个团队，16个供应商，80例患者）。在第6周、第12周和第36周使用患者健康问卷-9（PHQ-9）对患者进行评估。通过患者询问和电子记录确定接受治疗。评估了音频记录的指数遭遇的抑郁症状改善的介质（提供者的MI能力和患者的语言，有利于参与治疗或其他抑郁相关的情绪改善行为）。结果如下：在意向治疗分析中，MI-SMD与PHQ-9抑郁症状评分的更有利轨迹相关，而不是SMD单独治疗（随机分组x时间相互作用估计值= 0.13，p = 0.018）。36周时，与单独使用SMD相比，MI-SMD与抑郁症状改善（Cohen d = 0.41，95%CI [0.11，0.72]）和缓解率（成功率差异= 14.53 [1.79，27.26]）相关。MI-SMD与缓解的显著组x时间相互作用或抗抑郁药物或专业心理健康咨询的接受增加无关。提供者指导临床讨论治疗抑郁症的能力，以及患者支持参与改善情绪行为的语言，介导了MI-SMD对抑郁症状的影响（ps < .05）。讨论内容：培训提供者使用MI来组织关于抑郁症的讨论可能会改善抑郁症的标准管理。这篇文章的公共卫生意义是什么？这项研究的结果表明，在初级保健环境中，大多数抑郁症的人接受治疗，抑郁症的结果通常很差，结果可能会得到改善时，初级保健提供者使用动机访谈（MI）在临床讨论抑郁症。初级保健提供者也可能对学习MI感兴趣，因为它可以用于针对初级保健环境中普遍存在的一系列持久和有问题的健康相关行为。
Objective: To examine the effects of Motivational Interviewing (MI) conducted by primary care providers on rates of improvement over time for depressive symptoms and remission among low-income patients with newly diagnosed Major Depressive Disorder. Method: Ten care teams were randomized to MI with standard management of depression (MI-SMD; 4 teams, 10 providers, 88 patients) or SMD alone (6 teams, 16 providers, 80 patients). Patients were assessed at 6, 12 and 36 weeks with the Patient Health Questionnaire-9 (PHQ-9). Treatment receipt was ascertained through patient inquiry and electronic records. Audio-recorded index encounters were evaluated for mediators of improved depressive symptoms (providers' MI ability and patient language favoring participating in treatment or other depression related mood-improving behaviors). Results: In Intention-To-Treat analyses, MI-SMD was associated with a more favorable trajectory of PHQ-9 depressive symptom scores than SMD alone (randomization group x time interaction estimate = 0.13, p = .018). At 36 weeks, MI-SMD was associated with improved depressive symptoms (Cohen's d = 0.41, 95% CI [0.11, 0.72]) and remission rate (Success Rate Difference = 14.53 [1.79, 27.26]) relative to SMD alone. MI-SMD was not associated with a significant group x time interaction for remission, or with increased receipt of antidepressant medication or specialty mental health counseling. The providers' ability to direct clinical discussions toward treating depression, and the patients' language favoring engagement in mood-improving behaviors, mediated the effects of MI-SMD on depressive symptoms (ps < .05). Discussion: Training providers to frame discussions about depression using MI may improve upon standard management for depression.What is the public health significance of this article?The results of this study suggest that in primary care settings, where most depressed persons receive treatment and where depression outcomes are generally poor, outcomes may be improved when primary care providers use motivational interviewing (MI) during clinical discussions about depression. Primary care providers may also be interested in learning MI because it can be used to target a range of persistent and problematic health-related behaviors that are prevalent in primary care settings.