综合心理干预对社区慢性病患者的效果评价：一项源于社区的整群、随机、对照试验

背景：抑郁与焦虑经常出现在慢性躯体疾病患者中，通常这会加深这些躯体疾病所造成的损失，但是在中低等收入国家中这一问题却很少受到关注。
　　目标：评估非专业临床人员和志愿者进行以社区为基础的心理干预对缓解慢性躯体疾病患者抑郁和焦虑症状的疗效。
　　方法：将共计10,164名接受糖尿病或高血压治疗的上海社区居民任意分配到常规治疗组(n=2042)或干预组(n=8122)，对干预组的干预包括社区范围的心理健康教育、同伴支持小组和个人咨询。采用自评患者健康问卷(Paitent Health Quesitonnaire, PHQ-9)、广泛性焦虑量表(Generalized Anxiety Disorder scale, GAD-7)和12项健康状况调查问卷(12-item Short-Form Health Survey, SF-12)来评定基线和干预6个月后的抑郁症状、焦虑症状和生活质量。
　　结果：8813人完成了基线评估，其中16%的人有轻度或较严重的抑郁或焦虑症状（PHQ-9或GAD-7>5），并有4%的人伴有中度或重度抑郁或焦虑症状（PHQ-9或GAD-7>10）。本研究有效实施了干预内容中的健康教育部分，但是在符合条件成为同伴支持小组的成员中仅31%的对象接受了干预措施，接受个人咨询的仅9%。本研究脱落率较高(51%)，并且在完成和没有完成随访评估的人群之间存在显著差异。经过这些混杂因素的调整后，在完成两项评估的对象中，结果表明抑郁症状(F=9.98, p<0.001)、焦虑症状(F=12.85, p<0.001)以及SF-12中的心理部分总分(F=16.13, p<0.001)均得到显著改善。然而，自我报告未受控制的糖尿病或高血压的率没有显著变化。
　　结论：这些结果支持了以社区为基础的干预措施的可行性，以降低在精神科人力资源有限的中低等收入国家中慢性疾病患者抑郁和焦虑症状的严重程度。然而，在确认该措施广泛大规模实施前还有大量方法学上的挑战需在未来研究中解决。

A community-based controlled trial of a comprehensive psychological interveniton for community residents with diabetes or hypertension

Background:Depression and anxiety often occur in persons with chronic physical illnesses and typically magnify the impairment caused by these physical condiitons, but little atteniton has been paid to this issue in low-and middle-income countries.
Aim:Evaluate the effectiveness of a community-based psychological intervention administered by non-specialized clinicians and volunteers for alleviating depressive and anxiety symptoms in individuals with chronic physical illnesses.
Methods:A total of 10,164 community residents receiving treatment for diabetes or hypertension in Shanghai were arbitrarily assigned to a treatment-as-usual condiiton (n=2042) or an interveniton condiiton (n=8122) that included community-wide psychological health promoiton, peer support groups, and individual counseling sessions. The self-report Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and 12-item Short-Form Health Survey (SF-12) assessed depressive symptoms, anxiety symptoms, and quality of life at baseline and atfer the 6-month interveniton.
Results:Among the 8813 individuals who completed the baseline assessment, 16%had mild or more severe depressive or anxiety symptoms (PHQ-9 or GAD-7>5) and 4%had moderate or severe depressive or anxiety symptoms (PHQ-9 or GAD-7>10). The educaiton component of the interveniton was effecitvely implemented, but only 31%of those eligible for peer-support groups and only 9%of those eligible for individual counseling accepted these interventions. The dropout rate was high (51%), and there were significant differences between those who did and did not complete the follow-up assessment. After adjusitng for these confounding factors, the results in individuals who completed both assessments indicated that the intervention was associated with significant improvements in depressive symptoms (F=9.98, p<0.001), anxiety symptoms (F=12.85, p<0.001), and in the Mental Component Summary score of the SF-12 (F=16.13, p<0.001). There was, however, no significant change in the self-reported rates of uncontrolled diabetes or hypertension.
Conclusions:These results support the feasibility of implementing community-based interventions to reduce the severity of depressive and anxiety symptoms in persons with chronic medical condiitons in low-and middle-income countries where psychiatric manpower is very limited. However, there are substanital methodological challenges to mounitng such intervenitons that need to be resolved in future studies before the widespread up-scaling of this approach will be jusitifed.