Effectiveness of a Psychoeducational Group Intervention Carried Out by Nurses for Patients with Depression and Physical Comorbidity in Primary Care: Randomized Clinical Trial.

Antonia Raya-Tena,Luis Miguel Martín-López,Eva María Fernández-Linares,Susana González-Tejón,Elena Navas-Mendez,Glòria Sauch-Valmaña,Roser Masa-Font,Cèlia Cols-Sagarra,Rocío Casañas,Marc Casajuana-Closas,Jaume Martin-Royo,Quintí Foguet-Boreu,María Francisca Jiménez-Herrera,María Isabel Fernández-San-Martin,Jacobo Mendioroz-Peña

doi:10.3390/ijerph18062948

Abstract

The association between physical illness and depression implies a poorer management of chronic disease and a lower response to antidepressant treatments. Our study evaluates the effectiveness of a psychoeducational group intervention led by Primary Care (PC) nurses, aimed at patients of this kind. It is a randomized, multicenter clinical trial with intervention (IG) and control groups (CG), blind response variables, and a one year follow-up. The study included 380 patients ≥50 years of age from 18 PC teams. The participants presented depression (BDI-II > 12) and a physical comorbidity: diabetes mellitus type 2, ischemic heart disease, chronic obstructive pulmonary disease, and/or asthma. The IG (n = 204) received the psychoeducational intervention (12 weekly sessions of 90 min), and the CG (n = 176) had standard care. The patients were evaluated at baseline, and at 4 and 12 months. The main outcome measures were clinical remission of depressive symptoms (BDI-II ≤ 13) and therapeutic response (reduction of depressive symptoms by 50%). Remission was not significant at four months. At 12 months it was 53.9% in the IG and 41.5% in the CG. (OR = 0.61, 95% CI, 0.49–0.76). At 4 months the response in the IG (OR = 0.59, 95% CI, 0.44–0.78) was significant, but not at 12 months. The psychoeducational group intervention led by PC nurses for individuals with depression and physical comorbidity has been shown to be effective for remission at long-term and for therapeutic response at short-term.

Highlights

Depression affects around 300 million individuals worldwide, that is to say 4.4%of the population, and represents a frequent cause of morbidity, disability, and loss of productivity [1,2]
They were randomized into two groups: the intervention group (IG) (n = 204) who received the psychoeducational intervention, and the control group (CG) (n = 176) who had the usual clinical attention from their Primary Care (PC) physician/nurse
At one-year follow-up the BDI-II questionnaire had not been completed by 75 patients (IG n = 36, CG n = 39) which represents a drop-out rate of 17.6% and 22.2%, respectively

Summary

Introduction

Depression affects around 300 million individuals worldwide, that is to say 4.4%of the population, and represents a frequent cause of morbidity, disability, and loss of productivity [1,2]. The World Health Organization (WHO) estimates that depression will be the main health problem by 2030 [3] This disorder, which is common in Primary Care (PC) consultations, represents one of the main reasons for the loss of quality-adjusted life years (QALYs) [4]. Other studies with patients suffering from chronic obstructive pulmonary disease (COPD) have observed depression to be an indicator for emergency room care use and hospitalization due to acute exacerbation of the condition, irrespective of its severity. They have reported worse adherence to prescribed pharmacological treatment and a deterioration in quality of life [13,14,15,16]

Methods

Results

Discussion

Conclusion