Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial.
Limited effect of screening for depression with written feedback in outpatients with diabetes mellitus: a randomised controlled trial.
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DOI：
10.1007/s00125-010-2033-0
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发表时间：
2011-04
期刊：
影响因子：
8.2
通讯作者：
Snoek, F. J.
中科院分区：
文献类型：
--
作者：
Pouwer, F.;Tack, C. J.;Geelhoed-Duijvestijn, P. H. L. M.;Bazelmans, E.;Beekman, A. T.;Heine, R. J.;Snoek, F. J.
本研究的目的是测试抑郁症筛查程序（SCR）与常规护理（CAU）在糖尿病门诊患者中的有效性。测量的主要结局是抑郁评分，次要结局是精神保健消费、糖尿病痛苦和糖化血红蛋白。在一项多中心平行随机对照试验中，223名抑郁评分较高的糖尿病门诊患者被随机分配到SCR （n = 116）或CAU (n = 107)，使用计算机生成的数字。scr患者被邀请进行综合国际诊断访谈（CIDI）来诊断抑郁和/或焦虑（访谈者没有盲法分组分配）。作为干预的一部分，患者和他们的医生在一封信中被告知CIDI的结果，并提供治疗建议。在基线和6个月的随访中，使用流行病学研究中心抑郁量表（CES-D）和糖尿病问题领域调查（PAID）测量抑郁和糖尿病窘迫。HbA1c水平从医学图表中获取。两组平均CES-D抑郁评分从基线到6个月均下降（分别为24±8至21±8 [CAU]和26±7至22±10 [SCR] [p < 0.001]），组间差异无统计学意义。糖尿病窘迫和HbA1c在组内和组间均无显著变化。SCR组接受精神保健的患者比例从20%增加到28%，而CAU组为15%到18%。与CAU相比，对患者和医生进行书面反馈的抑郁症筛查并不能提高抑郁症评分，对精神卫生保健利用的影响也有限。似乎需要更强化的抑郁管理来改善糖尿病患者的抑郁结果。
The aim of this study was to test the effectiveness of a screening procedure for depression (SCR) vs care as usual (CAU) in outpatients with diabetes. The primary outcome measured was depression score and the secondary outcomes were mental healthcare consumption, diabetes-distress and HbA1c. In a multicentre parallel randomised controlled trial, 223 outpatients with diabetes, who had an elevated depression score, were randomly assigned to SCR (n = 116) or CAU (n = 107), using computer generated numbers. SCR-patients were invited for a Composite International Diagnostic Interview (CIDI) to diagnose depression and/or anxiety (interviewers were not blinded for group assignment). As part of the intervention, patients and their physicians were informed of the outcome of the CIDI in a letter and provided with treatment advice. At baseline and 6 month follow-up, depression and diabetes-distress were measured using the Centre for Epidemiologic Studies Depression Scale (CES-D) and the Problem Areas in Diabetes survey (PAID). HbA1c levels were obtained from medical charts. Mean CES-D depression scores decreased from baseline to 6 months in both groups (24 ± 8 to 21 ± 8 [CAU] and 26 ± 7 to 22 ± 10 [SCR] respectively [p < 0.001]), with no significant differences between groups. Neither diabetes-distress nor HbA1c changed significantly within and between groups. The percentage of patients receiving mental healthcare increased in the SCR group from 20% to 28%, compared with 15% to 18% in the CAU group. Depression screening with written feedback to patient and physician does not improve depression scores and has a limited impact on mental healthcare utilisation, compared with CAU. It appears that more intensive depression management is required to improve depression outcomes in patients with diabetes.
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影响因子：
8.2
作者：
Nouwen, A.;Winkley, K.;Twisk, J.;Lloyd, C. E.;Peyrot, M.;Ismail, K.;Pouwer, F.
通讯作者：
Pouwer, F.
影响因子：
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影响因子：
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影响因子：
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