Behavioural Activation versus Treatment as Usual for Depressed Older Adults in Primary Care: A Pragmatic Cluster-Randomised Controlled Trial.

IF 16.3 1区医学 Q1 PSYCHIATRY

Psychotherapy and Psychosomatics Pub Date : 2023-01-01 Epub Date: 2023-06-29 DOI:10.1159/000531201

Noortje P Janssen, Peter Lucassen, Marcus J H Huibers, David Ekers, Theo Broekman, Judith E Bosmans, Harm Van Marwijk, Jan Spijker, Richard Oude Voshaar, Gert-Jan Hendriks

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引用次数: 1

Abstract

Introduction: Effective non-pharmacological treatment options for depression in older adults are lacking.

Objective: The effectiveness of behavioural activation (BA) by mental health nurses (MHNs) for depressed older adults in primary care compared with treatment as usual (TAU) was evaluated.

Methods: In this multicentre cluster-randomised controlled trial, 59 primary care centres (PCCs) were randomised to BA and TAU. Consenting older (≥65 years) adults (n = 161) with clinically relevant symptoms of depression (PHQ-9 ≥ 10) participated. Interventions were an 8-week individual MHN-led BA programme and unrestricted TAU in which general practitioners followed national guidelines. The primary outcome was self-reported depression (QIDS-SR16) at 9 weeks and 3, 6, 9, and 12-month follow-up.

Results: Data of 96 participants from 21 PCCs in BA and 65 participants from 16 PCCs in TAU, recruited between July 4, 2016, and September 21, 2020, were included in the intention-to-treat analyses. At post-treatment, BA participants reported significantly lower severity of depressive symptoms than TAU participants (QIDS-SR16 difference = -2.77, 95% CI = -4.19 to -1.35), p < 0.001; between-group effect size = 0.90; 95% CI = 0.42-1.38). This difference persisted up to the 3-month follow-up (QIDS-SR16 difference = -1.53, 95% CI = -2.81 to -0.26, p = 0.02; between-group effect size = 0.50; 95% CI = 0.07-0.92) but not up to the 12-month follow-up [QIDS-SR16 difference = -0.89 (-2.49 to 0.71)], p = 0.28; between-group effect size = 0.29 (95% CI = -0.82 to 0.24).

Conclusions: BA led to a greater symptom reduction of depressive symptoms in older adults, compared to TAU in primary care, at post-treatment and 3-month follow-up, but not at 6- to 12-month follow-up.

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初级保健中抑郁老年人的行为激活与常规治疗：一项实用的聚类随机对照试验。

引言：老年人抑郁症缺乏有效的非药物治疗方案。目的：与常规治疗（TAU）相比，评估心理健康护士（MHN）在初级保健中对抑郁的老年人进行行为激活（BA）的有效性。方法：在这项多中心集群随机对照试验中，59个初级保健中心（PCCs）被随机分为BA和TAU。有临床相关抑郁症状（PHQ-9≥10）的同意老年（≥65岁）成年人（n=161）参与了研究。干预措施是由MHN领导的为期8周的个人BA计划和不受限制的TAU，全科医生遵循国家指导方针。主要结果是9周和3、6、9和12个月随访时的自我报告抑郁（QIDS-SR16）。结果：2016年7月4日至2020年9月21日期间招募的来自BA 21个PCC的96名参与者和来自TAU 16个PCC的65名参与者的数据被纳入意向治疗分析。在治疗后，BA参与者报告的抑郁症状严重程度显著低于TAU参与者（QIDS-SR16差异=-2.77，95%CI=-4.19至-1.35），p<；0.001；组间效应大小=0.90；95%可信区间=0.42-1.38）。这种差异持续到3个月随访（QIDS-SR16差异=1.53，95%可信区间-2.81至-0.26，p=0.02；组间效应大小=0.50；95%可信区间0.07-0.92），但没有持续到12个月随访[QIDS-SR16=-0.89（-2.49至0.71）]，p=0.28；组间效应大小=0.29（95%CI=0.82-0.24）。结论：与初级保健、治疗后和3个月随访中的TAU相比，BA能更大程度地减轻老年人的抑郁症状，但在6至12个月随访时没有。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.