背景:持续性抑郁障碍(PDD)普遍存在,使人衰弱。对于PDD患者,在多次治疗尝试失败后,建议将使用自我管理干预的精神康复作为下一个治疗步骤.“所有慢性疾病的患者和合作伙伴教育计划”(PPEP4All)是一个简短的,结构化的自我管理计划,侧重于患者及其合作伙伴/护理人员的功能恢复。在慢性躯体疾病人群中,PPEP4All已被证明是临床有效的。我们检查了PPEP4All是否适用于PDD(PPEP4All-PDD,与专业精神卫生保健中的常规照护(CAU)相比,每周9次小组或单个疗程)对患有PDD的成年人/老年人及其伴侣/护理人员也具有临床效果。
方法:在这项混合方法多中心实用随机对照试验中,70名PDD患者和14名合作伙伴/护理人员被分配到PPEP4All-PDD(患者,n=37;合作伙伴/护理人员,n=14)或CAU(患者,n=33;合作伙伴/护理人员,不包括)并在0、3、6和12个月时完成了关于抑郁症状的问卷,精神病理学,社会心理负担,心理韧性,和幸福/幸福。收集有关治疗满意度的定性数据。使用混合模型分析和意向治疗(ITT)方法分析数据。
结果:PPEP4All-PDD和CAU在临床疗效方面的任何结果均无统计学差异。抑郁症状的亚组分析未显示任何亚组的任何交互作用。尽管78%的参与者推荐PPEP4All-PDD,PPEP4All-PDD(评分=6.6;SD=1.7)和CAU(评分=7.6;SD=1.2)之间的治疗满意度没有差异,p=0.06。
结论:尽管抑郁症状相对于CAU没有改善,这仅证实治疗耐药PDD患者的治疗应从症状减轻转向功能恢复.此外,功能恢复可能反映在心理社会负担以外的其他结果上,比如自我授权,对治疗耐药的PDD患者。对PPEP4All-PDD的未来研究可以集中在长期计划和/或在线计划上,这些计划也可以在治疗过程的早期提供作为授权干预。试验注册:荷兰试验注册标识符NL5818。2016年7月20日注册https://clinicaltrialregister。nl/nl/试验/20302。
BACKGROUND: Persistent depressive disorder (PDD) is prevalent and debilitating. For patients with PDD, psychiatric rehabilitation using self-management interventions is advised as the next therapeutic step after multiple unsuccessful treatment attempts. The \"Patient and Partner Education Program for All Chronic Diseases\" (PPEP4All) is a brief, structured self-management program that focuses on functional recovery for patients and their partners/caregivers. In chronic somatic disorder populations, PPEP4All has already been shown to be clinically effective. We examined whether PPEP4All adapted for PDD (PPEP4All-PDD, nine weekly group or individual sessions) is also clinically effective for adults/elderly with PDD and their partners/caregivers compared to care-as-usual (CAU) in specialized mental healthcare.
METHODS: In this mixed-method multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners/caregivers were allocated to either PPEP4All-PDD (patients, n = 37; partners/caregivers, n = 14) or CAU (patients, n = 33; partners/caregivers, not included) and completed questionnaires at 0, 3, 6, and 12 months regarding depressive symptoms, psychopathology, psychosocial burden, mental resilience, and happiness/well-being. Qualitative data were collected regarding treatment satisfaction. Data were analyzed using mixed model analyses and an intention-to-treat (ITT) approach.
RESULTS: There was no statistically significant difference in any outcome regarding clinical effectiveness between PPEP4All-PDD and CAU. Subgroup analysis for depressive symptoms did not show any interaction effect for any subgroup. Although 78% of participants recommended PPEP4All-PDD, there was no difference in treatment satisfaction between PPEP4All-PDD (score = 6.6; SD = 1.7) and CAU (score = 7.6; SD = 1.2), p = 0.06.
CONCLUSIONS: Although depressive symptoms did not improve relative to CAU, this only confirmed that treatment for patients with treatment-resistant PDD should move from symptom reduction to functional recovery. Also, functional recovery may be reflected in other outcomes than psychosocial burden, such as self-empowerment, in patients with treatment-resistant PDD. Future research on PPEP4All-PDD could focus on a longer-term program and/or online program that may also be offered earlier in the treatment process as an empowerment intervention. TRIAL REGISTRATION: Netherlands Trial Register Identifier NL5818. Registered on 20 July 2016 https://clinicaltrialregister.nl/nl/trial/20302.