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首页> 外文期刊>JAMA: the Journal of the American Medical Association >Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: A randomized trial
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Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: A randomized trial

机译：电话管理与面对面认知行为治疗对基层医疗患者坚持治疗和抑郁结果的影响：一项随机试验

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Context: Primary care is the most common site for the treatment of depression. Most depressed patients prefer psychotherapy over antidepressant medications, but access barriers are believed to prevent engagement in and completion of treatment. The telephone has been investigated as a treatment delivery medium to overcome access barriers, but little is known about its efficacy compared with face-to-face treatment delivery. Objective: To examine whether telephone-administered cognitive behavioral therapy (T-CBT) reduces attrition and is not inferior to face-to-face CBT in treating depression among primary care patients. Design, Setting, and Participants: A randomized controlled trial of 325 Chicagoarea primary care patients with major depressive disorder, recruited from November 2007 to December 2010. Interventions: Eighteen sessions of T-CBT or face-to-face CBT. Main Outcome Measures: The primary outcome was attrition (completion vs noncompletion) at posttreatment (week 18). Secondary outcomes included masked interviewer-rated depression with the Hamilton Depression Rating Scale (Ham-D) and self-reported depression with the Patient Health Questionnaire-9 (PHQ-9). Results: Significantly fewer participants discontinued T-CBT (n=34; 20.9%) compared with face-to-face CBT (n=53; 32.7%; P=.02). Patients showed significant improvement in depression across both treatments (P<.001). There were no significant treatment differences at posttreatment between T-CBT and face-to-face CBT on the Ham-D (P=.22) or the PHQ-9(P=.89). The intention-to-treat posttreatment effect size on theHam-Dwas d=0.14 (90% CI,-0.05 to 0.33), and for the PHQ-9 it was d=-0.02 (90% CI,-0.20 to 0.17). Both results were within the inferiority margin of d=0.41, indicating that T-CBT was not inferior to face-to-face CBT. Although participants remained significantly less depressed at6-monthfollow-up relative to baseline (P<.001), participants receiving face-to-face CBT were significantly less depressed than those receiving T-CBT on the Ham-D (difference,2.91; 95% CI, 1.20-4.63;P<.001) and the PHQ-9 (difference, 2.12;95%CI, 0.68-3.56; P=.004). Conclusions: Among primary care patients with depression, providing CBT over the telephone compared with face-to-face resulted in lower attrition and close to equivalent improvement in depression at posttreatment. At 6-month follow-up, patients remained less depressed relative to baseline; however, those receiving face-to-face CBT were less depressed than those receiving T-CBT. These results indicate that T-CBT improves adherence compared with face-to-face delivery, but at the cost of some increased risk of poorer maintenance of gains after treatment cessation. Trial Registration: clinicaltrials.gov Identifier: NCT00498706.
机译：背景：基层医疗是治疗抑郁症的最常见部位。大多数抑郁症患者比抗抑郁药更喜欢心理治疗，但是据信进入障碍物会阻止患者参与治疗和完成治疗。已经研究了电话作为克服障碍的治疗传递媒介，但是与面对面的治疗传递相比，其功效知之甚少。目的：探讨电话管理的认知行为疗法（T-CBT）在初级保健患者中在抑郁症治疗中是否能减少磨损，且不逊于面对面的CBT。设计，背景和参与者：2007年11月至2010年12月，对325名芝加哥地区重症抑郁症初级保健患者进行了一项随机对照试验。干预措施：T-CBT或面对面CBT的18次治疗。主要结果指标：主要结果是治疗后（第18周）的损耗（完成与未完成）。次要结果包括用汉密尔顿抑郁量表（Ham-D）掩盖访调员评定的抑郁，用患者健康问卷9（PHQ-9）自我报告抑郁。结果：与面对面的CBT（n = 53; 32.7％; P = .02）相比，终止T-CBT的参与者明显减少（n = 34; 20.9％）。在两种治疗中，患者的抑郁症均有明显改善（P <.001）。 T-CBT和Ham-D（P = .22）或PHQ-9（P = .89）上的面对面CBT在治疗后没有显着差异。对Ham-Dwas的意向治疗后效应大小为d = 0.14（90％CI，-0.05至0.33），而对于PHQ-9，则为d = -0.02（90％CI，-0.20至0.17）。两项结果均在劣势范围d = 0.41之内，这表明T-CBT并不逊色于面对面的CBT。尽管与基线相比，随访6个月时参与者的抑郁情绪仍显着降低（P <.001），但接受面对面CBT的参与者的抑郁情绪明显低于接受Ham-D的T-CBT的参与者（差异，2.91; 95） ％CI，1.20-4.63; P ＜.001）和PHQ-9（差，2.12; 95％CI，0.68-3.56; P ＝ .004）。结论：在抑郁症的初级保健患者中，与面对面交流相比，通过电话提供CBT可以减少摩擦，并且在治疗后抑郁症的改善程度几乎相同。在6个月的随访中，相对于基线，患者的抑郁感有所减轻。但是，面对面接受CBT治疗的人比接受T-CBT治疗的人抑郁感要小。这些结果表明，与面对面分娩相比，T-CBT改善了依从性，但代价是停药后维持不良收益的风险增加。试用注册：clinicaltrials.gov标识符：NCT00498706。

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