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首页> 外文期刊>The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry >The Effect of Recent Bereavement on Outcomes in a Primary Care Depression Intervention Study
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The Effect of Recent Bereavement on Outcomes in a Primary Care Depression Intervention Study

机译：在初级保健抑郁症干预研究中，最近的丧亲之痛对结果的影响

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Objectives: Although bereavement and depression are both common in older primary care patients, the effect of bereavement on depression intervention outcomes is unknown. We examined whether standard interventions for depression in primary care were as effective for bereaved as for non-bereaved depressed patients. Design: Randomized controlled trial. Setting: Twenty community-based primary care practices in New York City, greater Philadelphia, and Pittsburgh. Randomization to either intervention or usual care occurred by practice. Participants: Patients aged 60 years or older who met criteria for major depression or clinically significant minor depression (N = 599). Patients who did not complete the bereavement measure or who were missing 4-month data were excluded (final N = 417). Intervention: Study-trained depression care managers offered guideline-concordant recommendations to primary care physicians at intervention sites and assisted patients with treatment adherence. Patients who did not wish to take antidepressants could receive interpersonal psychotherapy. Measurements: Bereavement was captured using the Louisville Older Persons Events Schedule. Depression severity was assessed using the 24-item Hamilton Depression Rating Scale (HDRS). Outcomes at 4 months were remission (HDRS <= 7) and response (HDRS reduction >= 50% from baseline). Results: Logistic regressions indicated that, for non-bereaved participants, response and remission were higher in intervention than usual care. However, recently bereaved older adults were less likely to achieve response or remission at 4 months if treated in the intervention condition. Conclusions: Standard depression care management appears to be ineffective among recently bereaved older primary care patients. Greater attention should be paid in primary care to emotional distress in the context of bereavement.
机译：目的：虽然丧亲和抑郁在老年初级保健患者中都很常见，但丧亲对抑郁干预结果的影响尚不清楚。我们检查了初级保健中抑郁症的标准干预措施对于丧亲者是否与非丧亲者一样有效。设计：随机对照试验。地点：纽约市，大费城和匹兹堡有20种基于社区的初级保健实践。通过实践随机分配到干预或常规护理。参加者：符合重度抑郁或临床上显着的轻度抑郁症标准的60岁或60岁以上患者（N = 599）。未完成丧亲测量或缺少4个月数据的患者被排除（最终N = 417）。干预：受过训练的抑郁症护理经理向干预现场的初级保健医生提供了指导方针相符的建议，并协助患者坚持治疗。不想服用抗抑郁药的患者可以接受人际心理治疗。测量：丧亲是使用路易斯维尔老年人活动时间表捕获的。使用24个项目的汉密尔顿抑郁等级量表（HDRS）评估抑郁的严重程度。 4个月时的结果是缓解（HDRS <= 7）和缓解（HDRS减少> =基线的50％）。结果：Logistic回归表明，对于非丧亲者，干预措施的反应和缓解程度高于常规护理。但是，如果在干预条件下进行治疗，则失去亲人的老年人在4个月时较难获得缓解或缓解。结论：在最近失去亲人的老年初级保健患者中，标准的抑郁症护理管理似乎无效。在丧亲的背景下，应更加重视对情绪困扰的初级保健。

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