Improving depression outcomes in older adults with comorbid medical illness
Improving depression outcomes in older adults with comorbid medical illness
复制标题
DOI：
10.1016/j.genhosppsych.2004.09.004
复制
发表时间：
2005-01-01
影响因子：
7
通讯作者：
Unützer, J
中科院分区：
文献类型：
--
作者：
Harpole, LH;Williams, JW;Unützer, J
背景：抑郁症在老年人中很常见，常常与多种慢性疾病并存，这可能会使其诊断和治疗复杂化。目的：确定多种并存内科疾病的存在是否影响患者对多学科抑郁症治疗方案的反应。设计、背景和参与者：改善情绪促进获得协同治疗(IMPACT)的预先计划分析，1801名抑郁症老年人(大于或等于60岁)的随机对照试验，于1999年7月至2001年8月在美国5个州8个医疗机构的18个初级保健诊所进行。干预：干预患者可以在长达12个月的时间内与抑郁症护理经理会面，由精神病学家和初级保健专家监督，由患者的初级保健医生提供教育、护理管理和抗抑郁药物治疗的支持，或提供简短的心理治疗(初级保健中的问题解决治疗)。测量：抑郁，生活质量(QOL；在基线、3个月、6个月和12个月评定患者的心理健康状况。结果：患者平均患有3.8种慢性疾病。尽管有更多慢性疾病的患者在基线时抑郁严重程度更高，但与通常的护理相比，慢性病的数量并不影响对影响干预的反应的可能性。在所有随访时间点，干预组患者的抑郁程度均明显低于不伴其他疾病的常规护理组(P
Background: Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment.Objective: To determine whether or not the presence of multiple comorbid medical illnesses affects patient response to a multidisciplinary depression treatment program.Design, Setting and Participants: Preplanned analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (greater than or equal to 60 years), which was performed at 18 primary care clinics from eight health care organizations in five states across the United States from July 1999 to August 2001.Intervention: Intervention patients had access for up to 12 months to a depression care manager, supervised by a psychiatrist and a primary care expert, who offered education, care management and support of antidepressant management by the patient's primary care physician, or provided brief psychotherapy (Problem-Solving Treatment in Primary Care).Measurements: Depression, quality of life (QOL; scale of 0- 10) and mental health component score (MCS) of the Short-Form 12 assessed at baseline, 3, 6 and 12 months.Results: Patients suffered from an average of 3.8 chronic medical conditions. Although patients with more chronic medical conditions had higher depression severity at baseline, the number of chronic diseases did not affect the likelihood of response to the IMPACT intervention when compared to care as usual. Intervention patients experienced significantly lower depression during all follow-up time points as compared with patients in usual care independent of other comorbid illnesses (P