Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care.
Task shifting interpersonal counseling for depression: a pragmatic randomized controlled trial in primary care.
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DOI：
10.1186/s12888-017-1379-y
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发表时间：
2017-06-21
期刊：
影响因子：
4.4
通讯作者：
Mello MF
中科院分区：
文献类型：
--
作者：
Matsuzaka CT;Wainberg M;Norcini Pala A;Hoffmann EV;Coimbra BM;Braga RF;Sweetland AC;Mello MF
建议采用任务转移方法（在卫生工作队伍中合理重新分配任务），培训非专业人员，协助将心理健康治疗纳入初级保健，以缩小低收入和中等收入国家抑郁症的心理健康治疗差距。本研究的目的是研究一种新的模式，抑郁症护理在低资源环境相比，在平时加强治疗（E-TAU）。我们培训了非专业社区卫生工作者（公共卫生系统的当地非专业雇员），以提供人际咨询（IPC）来治疗巴西圣保罗市的抑郁症状，家庭健康战略（FHS）。我们进行了一项随机对照试验，涉及86例目前患有重度抑郁症或恶劣心境障碍（基于DSM-IV）的患者，这些患者是从FHS诊所招募的。参与者被随机分配至IPC干预组（n = 43）或E-TAU组（n = 43）。分配到IPC的参与者接受了社区卫生工作者提供的3-4次会议;研究心理学家跟踪E-TAU参与者，以促进他们转介到公共系统内的专门精神卫生保健。使用汉密尔顿评定量表（HDRS-17）和患者健康问卷（PHQ-9）评估抑郁症状的减轻;使用自我报告问卷（SRQ）测量轻微精神障碍（包括抑郁、焦虑和躯体形式症状）;使用临床总体印象量表在2个月内测量功能。意向治疗分析显示，两组在2个月内症状均有显著改善，但两组之间无显著差异。符合方案分析显示IPC组的HDRS-17结局显著更好。在低收入和中等收入国家培训非专家社区卫生工作者提供IPC可能是减轻抑郁症负担的成功策略，也可能是低收入环境中不可能的专家主导服务的低成本和有效替代方案。巴西临床试验，编号RBR-5 qhmb 5（试验网址：http：//www.ensaiosclinicos.gov.br/rg/RBR-5qhmb5/），于2013年5月1日之后回顾性注册。
Task shifting approaches (rational redistribution of tasks among health workforce teams) to train lay professionals to assist with integrating mental health treatment in primary care has been recommended to close the mental health treatment gap for depression in low- and middle-income countries. This study aims to examine the a new model for depression care in a low-resource environment compared to enhanced treatment at usual (E-TAU). We trained non-specialist community health workers (local lay employees of the public health system) to provide Interpersonal Counseling (IPC) to treat depressive symptoms in the Brazilian, São Paulo city, family health strategy (FHS). We conducted a randomized controlled trial involving 86 patients with a current major depressive disorder or dysthymia (based on DSM-IV) recruited from an FHS clinic. Participants were randomized to IPC intervention (n = 43) or E-TAU (n = 43). Participants allocated to IPC received 3–4 sessions provided by community health workers; research psychologists followed the E-TAU participants to facilitate their referral to specialized mental health care within the public system. Reduction of depressive symptoms was assessed using the Hamilton Rating Scale (HDRS-17) and the Patient Health Questionnaire (PHQ-9); minor psychiatric symptomatology (including depression, anxiety and somatoform symptoms) were measured using the Self Reporting Questionnaire (SRQ); and functioning was measured by the Clinical Global Impression Scale over a 2-month period. Intention-to-treat analysis showed significant improvement on symptoms for both groups over 2 months, without significant differences between them. Per-protocol analysis showed significant better HDRS-17 outcomes for the IPC group. Training non-specialist community health workers in low- and middle-income countries to provide IPC could be a successful strategy in reducing the burden of depression and also potentially a low-cost and effective alternative to specialist-led services that might not be possible in low income settings. Brazilian Clinical Trials, number RBR-5qhmb5 (trial url: http://www.ensaiosclinicos.gov.br/rg/RBR-5qhmb5/), retrospectively registered after May 1, 2013.