{"id":20266,"date":"2021-06-11T05:33:00","date_gmt":"2021-06-10T21:33:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=20266"},"modified":"2021-06-12T07:03:55","modified_gmt":"2021-06-11T23:03:55","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%95%b0%e5%ad%97%e5%b9%b2%e9%a2%84%e5%af%b9%e5%b7%b4%e8%a5%bf%e5%92%8c%e7%a7%98%e9%b2%81%e5%90%88%e5%b9%b6%e9%ab%98%e8%a1%80%e5%8e%8b%e6%88%96","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=20266","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6570\u5b57\u5e72\u9884\u5bf9\u5df4\u897f\u548c\u79d8\u9c81\u5408\u5e76\u9ad8\u8840\u538b\u6216\u7cd6\u5c3f\u75c5\u60a3\u8005\u6291\u90c1\u75c7\u72b6\u7684\u5f71\u54cd"},"content":{"rendered":"\n

Original Investigation May 11, 2021<\/p>\n\n\n\n

Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials<\/h1>\n\n\n\n

Ricardo\u00a0Araya,\u00a0Paulo Rossi\u00a0Menezes,\u00a0Helo\u00edsa Garcia\u00a0Claro,\u00a0et al<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>2021;325(18):1852-1862. doi:10.1001\/jama.2021.4348<\/h3>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown.<\/p>\n\n\n\n

Objective<\/strong>  To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and\/or hypertension.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score \u226510) who were being treated for hypertension and\/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in S\u00e3o Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018).<\/p>\n\n\n\n

Interventions<\/strong>  An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n\u2009=\u2009440 participants in 10 clusters in S\u00e3o Paulo; n\u2009=\u2009217 participants in Lima) vs enhanced usual care (n\u2009=\u2009440 participants in 10 clusters in S\u00e3o Paulo; n\u2009=\u2009215 participants in Lima).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months.<\/p>\n\n\n\n

Results<\/strong>  Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in S\u00e3o Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159\/391 participants) in the digital intervention group vs 28.6% (114\/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P<\/em>\u2009=\u2009.001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108\/205 participants) in the digital intervention group vs 34.1% (70\/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P<\/em>\u2009<\u2009.001). At 6-month follow-up, differences across groups were no longer statistically significant.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov: NCT02846662<\/a> (S\u00e3o Paulo) and NCT03026426<\/a> (Lima)<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation May 11, 2021 Effe […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20266"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=20266"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20266\/revisions"}],"predecessor-version":[{"id":20267,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/20266\/revisions\/20267"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=20266"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=20266"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=20266"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}