■抑郁和焦虑在痴呆症患者(PLWD)中很常见且有害。目前尚不清楚常规提供的心理治疗是否可以帮助减轻PLWD的这些症状。这项研究旨在调查在PLWD的初级保健心理治疗服务中提供的治疗过程中抑郁和焦虑症状的改善,并比较无痴呆症患者的预后。
■来自英格兰改善获得心理治疗服务(IAPT)的国家数据与医院事件统计数据相关联,心理健康服务数据集,和HES-ONS死亡率数据用于确定2012-2019年期间完成IAPT心理治疗的1,549名PLWD和倾向评分匹配的对照组,未发现痴呆.结果指标包括干预前后抑郁(PHQ-9)和焦虑(GAD-7)症状的变化和治疗结果(可靠的改善,recovery,恶化)。
■在心理治疗过程中,抑郁(t(1548)=31·05,p<·001)和焦虑(t(1548)=30·31,p<·001)的症状得到了改善(抑郁:d=-0·83;焦虑:d=-0·80)。然而,PLWD不太可能可靠地改善(OR=·75,95CI[·63,·88],p<·001)或恢复(OR=·75,95CI[·64,·88],p=·001),更有可能恶化(OR=1·35,95CI[1·03,1·78],p=·029)比没有痴呆的匹配对照样品。
■心理治疗可能对患有抑郁或焦虑的PLWD有益,但它目前不如没有痴呆症的人有效。需要更多的研究来改善获得心理治疗的机会,并了解这种差异以及如何调整治疗以进一步改善结果。
■这项工作得到了阿尔茨海默氏症协会的支持。
UNASSIGNED: Depression and anxiety are common and deleterious in people living with dementia (PLWD). It is currently unknown whether routinely provided psychological therapy can help reduce these symptoms in PLWD. This study aimed to investigate improvements in depression and anxiety symptoms over the course of therapy offered in primary care psychological therapy services in PLWD and to compare outcomes to people without dementia.
UNASSIGNED: National data from Improving Access to Psychological Therapies services (IAPT) across England linked with Hospital Episode Statistics data, the Mental Health Services Dataset, and HES-ONS mortality data were used to identify 1,549 PLWD who completed a course of psychological treatment in IAPT between 2012-2019 and a propensity score matched control group without identified dementia. Outcome measures included pre-post intervention changes in depression (PHQ-9) and anxiety (GAD-7) symptoms and therapy outcomes (reliable improvement, recovery, deterioration).
UNASSIGNED: Symptoms of depression (t(1548)=31·05, p<·001) and anxiety (t(1548)=30·31, p<·001) improved in PLWD over the course of psychological therapy with large effect sizes (depression: d=-0·83; anxiety: d=-0·80). However, PLWD were less likely to reliably improve (OR=·75, 95%CI[·63,·88], p<·001) or recover (OR=·75, 95%CI[·64,·88], p=·001), and more likely to deteriorate (OR=1·35, 95%CI[1·03,1·78], p=·029) than a matched control sample without dementia.
UNASSIGNED: Psychological therapy may be beneficial for PLWD with depression or anxiety, but it is currently not as effective as for people without dementia. More research is needed to improve access to psychological therapies and to understand this discrepancy and how therapies can be adapted to further improve outcomes.
UNASSIGNED: This work was supported by the Alzheimer\'s Society.