在综合医疗环境中通过问题聚焦式短期疗法解决抑郁和共病健康状况：一项随机临床试验。

Addressing depression and comorbid health conditions through solution-focused brief therapy in an integrated care setting: a randomized clinical trial.

机构信息

School of Social Work, University of Georgia, Williams Street, Atlanta, GA, 30602, Georgia.

Department of Family and Preventative Medicine, School of Medicine, Emory University, Atlanta, Georgia.

出版信息

BMC Prim Care. 2024 Aug 23;25(1):313. doi: 10.1186/s12875-024-02561-8.

DOI:10.1186/s12875-024-02561-8

PMID:39179982

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11342549/

Abstract

BACKGROUND

Co-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings.

PURPOSE

Our paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group.

METHODS

A randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c).

RESULTS

Of 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant.

CONCLUSION

The SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention.

TRIAL REGISTRATION

The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation.

摘要

背景

身心共病的情况很常见，但在基层医疗环境中需要有效的、可持续的干预措施。

目的

本文分析了以问题为导向的简短治疗（Solution-Focused Brief Therapy，SFBT）干预措施在基层医疗中治疗抑郁和共病的有效性。我们假设接受 SFBT 干预的个体在抑郁和焦虑症状、收缩压（Systolic Blood Pressure，SBP）、血红蛋白 A1C（Hemoglobin A1C，HbA1c）和体重指数（Body Mass Index，BMI）方面与对照组相比会有统计学上显著的降低。此外，我们假设 SFBT 组的幸福感评分会高于对照组。

方法

一项随机临床试验在一家农村联邦合格的健康中心进行。符合条件的参与者 PHQ-9 得分≥10，且通过图表审查符合共病健康状况（高血压、肥胖、糖尿病）的标准。SFBT 组（n=40）在三个星期内接受了三次 SFBT 干预，同时接受了常规治疗（TAU）。对照组（n=40）在三个星期内接受了 TAU。测量包括抑郁（PHQ-9）和焦虑（GAD-7）、幸福感（人类繁荣指数）和 SFBT 评分，以及身体健康结果（血压、体重指数和血红蛋白 A1c）。

结果

在 80 名同意参与的参与者中，有 69 名完成了所有的测量并被纳入最终分析。80%的参与者为女性，平均年龄为 38.1 岁（标准差=14.5）。大多数参与者为白人（72%），其次是西班牙裔（15%）和黑人（13%）。与 TAU 相比，SFBT 干预组的抑郁（基线：M=18.17，SD=3.97，结局：M=9.71，SD=3.71）和焦虑（基线：M=14.69，SD=4.9，结局：M=8.43，SD=3.79）显著降低。与 TAU 相比，SFBT 干预组的幸福感评分也显著增加（基线：M=58.37，SD=16.36，结局：M=73.43，SD=14.70）。BMI 和血压的变化没有统计学意义。