Intervention to Prevent Major Depression in Primary Care A Cluster Randomized Trial

被引：27

作者：

Angel Bellon, Juan

Conejo-Ceron, Sonia ^{[2
]}

Moreno-Peral, Patricia ^{[2
]}

King, Michael ^{[1
]}

Nazareth, Irwin ^{[3
]}

Martin-Perez, Carlos ^{[4
]}

Fernandez-Alonso, Carmen ^{[5
]}

Rodriguez-Bayon, Antonina ^{[6
]}

Fernandez, Anna ^{[7
]}

Maria Aiarzaguena, Jose ^{[8
]}

Monton-Franco, Carmen ^{[9
]}

Ibanez-Casas, Inmaculada ^{[10
]}

Rodriguez-Sanchez, Emiliano ^{[11
]}

Isabel Ballesta-Rodriguez, Maria ^{[12
]}

Serrano-Blanco, Antoni ^{[13
]}

Cruz Gomez, Maria ^{[14
]}

LaFuente, Pilar ^{[15
]}

del Mar Munoz-Garcia, Maria ^{[2
]}

Minguez-Gonzalo, Pilar ^{[16
]}

Araujo, Luz ^{[2
]}

Palao, Diego ^{[17
]}

Bully, Paola ^{[14
]}

Zubiaga, Fernando ^{[18
]}

Navas-Campana, Desiree ^{[2
]}

Mendive, Juan ^{[19
]}

Manuel Aranda-Regules, Jose ^{[20
]}

Rodriguez-Morejon, Alberto ^{[21
]}

Salvador-Carulla, Luis ^{[7
]}

de Dios Luna, Juan ^{[22
]}

机构：

[1] UCL, Div Psychiat, Charles Bell House,67-73 Riding House St, London W1W 7EH, England

[2] Unidad Invest, Dist Atenc Primaria Malaga Guadalhorce, C Sevilla,23,3a Planta, Malaga 29009, Spain

[3] UCL, Dept Primary Care & Populat Hlth, Royal Free Site,Rowland Hill St, London NW3, England

[4] Dist Sanitario Granada Nordeste, Ctr Salud Marquesado, Ave Mariana Pineda S-N, Granada 18500, Spain

[5] Gerencia Reg Salud Castilla & Leon, Paseo Zorrilla 1, Valladolid 47007, Spain

[6] Ctr Salud San Jose, Plaza Juanfra Garrido Romera S-N, Jaen 23700, Spain

[7] Univ Sydney, Ctr Disabil Res & Policy, Brain & Mind Res Inst, Fac Hlth Sci, Cumberland Campus 75 East St, Lidcombe, NSW 2141, Australia

[8] Ctr Salud San Ignacio, Larrakotorre Kalea 9, Bilbao 48015, Bizkaia, Spain

[9] Ctr Salud Casablanca, C Vinedo Viejo 10, Zaragoza 50009, Spain

[10] Univ Granada, Ctr Invest Biomed Red Salud Mental, Fac Med, PTS Avda Invest, Granada 18016, Spain

[11] Ctr Salud La Alamedilla, Unidad Invest, Ave Comuneros 27-31, Salamanca 37003, Spain

[12] Ctr Salud Federico Castillo, C Ramo n Espantaleon S-N, Jaen 23005, Spain

[13] Parc Sanitari Sant Joan de Deu, C Dr Antoni Pujadas 42, Barcelona 08830, Spain

[14] Unidad Invest Atenc Primaria, C Luis Power 18-4, Bilbao 48014, Spain

[15] Ctr Salud Andorra, C Huesca 0, Teruel 44500, Spain

[16] Gerencia Reg Salud Castilla Leon, Unidad Invest, Paseo Zorrilla 1, Valladolid 47007, Spain

[17] Hosp Parc Tauli, Serv Salut Mental, Parc Tauli 1, Barcelona 08208, Spain

[18] Ctr Salud Arrabal, Unidad Invest Atenc Primaria, Andador Aragues Puerto 2-4, Zaragoza 50015, Spain

[19] Ctr Salud La Mina, C Mar S-N, Barcelona 08930, Spain

[20] Ctr San Andres Torcal, Malaga 29003, Spain

[21] Univ Malaga, Dept Personalidad Evaluac & Tratamiento Psicol, Fac Psicol, Campus Teatinos S-N, Malaga 29590, Spain

[22] Univ Granada, Dept Bioestadist, Fac Med, Parque Tecnol Ciencias Salud,Avda Invest 11, Granada 18016, Spain

来源：

ANNALS OF INTERNAL MEDICINE | 2016年 / 164卷 / 10期

关键词：

GENERAL-PRACTICE ATTENDEES; INTERNATIONAL DIAGNOSTIC INTERVIEW; RISK PREDICTION ALGORITHM; MENTAL-DISORDERS; GLOBAL BURDEN; ONSET; VALIDATION; POPULATION; EPISODES; DISEASE;

D O I：

10.7326/M14-2653

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Not enough is known about universal prevention of depression in adults. Objective: To evaluate the effectiveness of an intervention to prevent major depression. Design: Multicenter, cluster randomized trial with sites randomly assigned to usual care or an intervention. (ClinicalTrials.gov:NCT01151982) Setting: 10 primary care centers in each of 7 cities in Spain. Participants: Two primary care physicians (PCPs) and 5236 nondepressed adult patients were randomly sampled from each center; 3326 patients consented and were eligible to participate. Intervention: For each patient, PCPs communicated individual risk for depression and personal predictors of risk and developed a psychosocial program tailored to prevent depression. Measurements: New cases of major depression, assessed every 6 months for 18 months. Results: At 18 months, 7.39% of patients in the intervention group (95% CI, 5.85% to 8.95%) developed major depression compared with 9.40% in the control (usual care) group (CI, 7.89% to 10.92%) (absolute difference, -2.01 percentage points [CI, -4.18 to 0.16 percentage points]; P = 0.070). Depression incidence was lower in the intervention centers in 5 cities and similar between intervention and control centers in 2 cities. Limitation: Potential self-selection bias due to nonconsenting patients. Conclusion: Compared with usual care, an intervention based on personal predictors of risk for depression implemented by PCPs provided a modest but nonsignificant reduction in the incidence of major depression. Additional study of this approach may be warranted.

引用

页码：656 / +

页数：11

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