Feasibility of implementing mobile technology-delivered mental health treatment in routine adult sickle cell disease care
Feasibility of implementing mobile technology-delivered mental health treatment in routine adult sickle cell disease care
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DOI：
10.1093/tbm/iby107
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发表时间：
2020-02-01
影响因子：
3.6
通讯作者：
Sarkar, Urmimala
中科院分区：
文献类型：
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作者：
Jonassaint, Charles R.;Kang, Chaeryon;Sarkar, Urmimala
镰状细胞病（SCD）是一种严重的血红蛋白病，其特征是急性和慢性疼痛。这种疾病的患者，其中大多数是代表性不足的少数民族，患精神疾病的风险增加。本研究的目的是测试计算机化认知行为疗法（cCBT）干预的可接受性和实施，击败蓝调，以改善SCD患者的抑郁，焦虑和疼痛。患有SCD且有显著抑郁症状（患者健康问卷[PHQ-9]评分>= 10）或焦虑症状（广泛性焦虑障碍量表[GAD-7]评分>= 10）的成年人有资格参与，并随机接受8次cCBT治疗，并接受护理教练支持或常规治疗。参与者使用移动的日记应用程序报告每日疼痛和情绪症状。在1个月、3个月和6个月时评估抑郁、焦虑和疼痛症状。30例患者入组：18例接受cCBT，12例接受对照。cCBT干预在临床环境中实施是可行的，并为参与者所接受。cCBT组患者在6个月时报告的抑郁下降幅度（-3.82，SE = 1.30）略大于对照组（-0.50，SE = 1.60; p = 0.06）。治疗对焦虑无显著影响;然而，cCBT与通过移动的日记应用程序报告的每日疼痛改善相关（p = 0.014）。通过移动终端提供的cCBT是为患有SCD的成年人提供心理健康护理的可行策略。cCBT对于目标人群是可接受的;能够在现实世界的非理想条件下实施;并且有可能改善患者报告的结局。
Sickle cell disease (SCD) is a severe hemoglobinopathy characterized by acute and chronic pain. Sufferers of the disease, most of whom are underrepresented minorities, are at increased risk for mental health disorders. The purpose of this study is to test the acceptability and implementation of a computerized cognitive behavioral therapy (cCBT) intervention, Beating the Blues, to improve depression, anxiety, and pain in patients with SCD. Adults with SCD and significant symptoms of depression (Patient Health Questionnaire [PHQ-9] score >= 10) or anxiety (Generalized Anxiety Disorder Scale [GAD-7] score >= 10) were eligible to participate and be randomized to either receive eight sessions of cCBT with care coach support or treatment as usual. Participants reported daily pain and mood symptoms using a mobile diary app. Depression, anxiety, and pain symptoms were assessed at 1, 3, and 6 months. Thirty patients were enrolled: 18 to cCBT, and 12 to control. The cCBT intervention was feasible to implement in clinical settings and acceptable to participants. Patients in the cCBT arm reported a marginally greater decrease in depression at 6 months (-3.82, SE = 1.30) than those in the control group (-0.50, SE = 1.60; p =.06). There were no significant effects of treatment on anxiety; however, cCBT was associated with improved daily pain reported via a mobile diary app (p =.014). cCBT, delivered via mobile device, is a feasible strategy to provide mental health care to adults living with SCD. cCBT was acceptable to the target population; was able to be implemented in real-world, nonideal conditions; and has the potential to improve patient-reported outcomes.