UNASSIGNED: The authors used a type-2 hybrid effectiveness-implementation, patient-randomized trial to compare bCBT with enhanced usual care. Participants (N=189) with moderate symptoms of depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) were enrolled from CBOCs in the southern United States. bCBT (N=109) consisted of three to six sessions, delivered by mental health providers (N=17) as part of routine clinic practices. Providers received comprehensive training and support to facilitate bCBT delivery. Recipients of enhanced usual care (N=80) were given educational materials and encouraged to discuss treatment options with their primary care provider. The primary effectiveness outcome was PHQ-9-assessed depression symptoms posttreatment (4 months after baseline) and at 8- and 12-month follow-ups. Implementation outcomes focused on bCBT dose received, provider fidelity, and satisfaction with bCBT training and support.
UNASSIGNED: bCBT improved depression symptoms (Cohen\'s d=0.55, p<0.01) relative to enhanced usual care posttreatment, and the improvement was maintained at 8- and 12-month follow-ups (p=0.004). bCBT participants received a mean±SD of 3.7±2.7 sessions (range 0-9), and 64% completed treatment (≥3 sessions). Providers delivered bCBT with fidelity and reported that bCBT training and support were feasible and effective.
UNASSIGNED: bCBT had a modest treatment footprint of approximately four sessions, was acceptable to participants and providers, was feasible for delivery in CBOCs, and produced meaningful sustained improvements in depression.
■作者使用了2型混合有效性-实现,患者随机试验比较bCBT与强化常规护理。来自美国南部CBOCs的中度抑郁症状(患者健康问卷-9[PHQ-9]评分≥10)的参与者(N=189)。bCBT(N=109)包括三到六次会议,由精神卫生提供者(N=17)作为常规诊所实践的一部分提供。提供商接受了全面的培训和支持,以促进bCBT交付。接受强化常规护理(N=80)的患者接受了教育材料,并鼓励他们与初级保健提供者讨论治疗方案。主要有效性结果是治疗后(基线后4个月)以及8个月和12个月随访时的PHQ-9评估的抑郁症状。实施成果侧重于收到的bCBT剂量,提供者保真度,以及对bCBT培训和支持的满意度。
■bCBT改善了抑郁症状(Cohen'sd=0.55,p<0.01),并且在8个月和12个月的随访中保持了改善(p=0.04)。bCBT参与者平均±SD为3.7±2.7次(范围0-9),64%完成治疗(≥3次)。提供商向bCBT提供了保真度,并报告说bCBT培训和支持是可行和有效的。
■bCBT的治疗足迹适中,约为四个疗程,参与者和提供者都可以接受,在社区门诊诊所分娩是可行的,并对抑郁症产生了有意义的持续改善。