The Coronavirus Disease 2019 (COVID-19) epidemic emerged in Wuhan, China, spread nationwide and then onto half a dozen other countries between December 2019 and early 2020. The implementation of unprecedented strict quarantine measures in China has kept a large number of people in isolation and affected many aspects of people’s lives. It has also triggered a wide variety of psychological problems, such as panic disorder, anxiety and depression. This study is the first nationwide large-scale survey of psychological distress in the general population of China during the COVID-19 epidemic.
A B S T R A C T PurposeTo determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia. Patients and MethodsStudy patients included 472 low-income, predominantly female Hispanic patients with cancer age Ն 18 years with major depression (49%), dysthymia (5%), or both (46%). Patients were randomly assigned to intervention (n ϭ 242) or enhanced usual care (EUC; n ϭ 230). Intervention patients had access for up to 12 months to a depression clinical specialist (supervised by a psychiatrist) who offered education, structured psychotherapy, and maintenance/relapse prevention support. The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication. ResultsAt 12 months, 63% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 (PHQ-9) depression scale compared with 50% of EUC patients (odds ratio [OR] ϭ 1.98; 95% CI, 1.16 to 3.38; P ϭ .01). Improvement was also found for 5-point decrease in PHQ-9 score among 72.2% of intervention patients compared with 59.7% of EUC patients (OR ϭ 1.99; 95% CI, 1.14 to 3.50; P ϭ .02). Intervention patients also experienced greater rates of depression treatment (72.3% v 10.4% of EUC patients; P Ͻ .0001) and significantly better quality-of-life outcomes, including social/family (adjusted mean difference between groups, 2.7; 95% CI, 1.22 to 4.17; P Ͻ .001), emotional (adjusted mean difference, 1.29; 95% CI, 0.26 to 2.22; P ϭ .01), functional (adjusted mean difference, 1.34; 95% CI, 0.08 to 2.59; P ϭ .04), and physical well-being (adjusted mean difference, 2.79; 95% CI, 0.49 to 5.1; P ϭ .02). ConclusionADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms, improvement in quality of life, and lower pain levels compared with EUC for patients with depressive disorders in a low-income, predominantly Hispanic population in public sector oncology clinics.
OBJECTIVETo determine whether evidence-based socioculturally adapted collaborative depression care improves receipt of depression care and depression and diabetes outcomes in low-income Hispanic subjects.RESEARCH DESIGN AND METHODSThis was a randomized controlled trial of 387 diabetic patients (96.5% Hispanic) with clinically significant depression recruited from two public safety-net clinics from August 2005 to July 2007 and followed over 18 months. Intervention (INT group) included problem-solving therapy and/or antidepressant medication based on a stepped-care algorithm; first-line treatment choice; telephone treatment response, adherence, and relapse prevention follow-up over 12 months; plus systems navigation assistance. Enhanced usual care (EUC group) included standard clinic care plus patient receipt of depression educational pamphlets and a community resource list.RESULTSINT patients had significantly greater depression improvement (≥50% reduction in Symptom Checklist-20 depression score from baseline; 57, 62, and 62% vs. the EUC group's 36, 42, and 44% at 6, 12, and 18 months, respectively; odds ratio 2.46–2.57; P < 0.001). Mixed-effects linear regression models showed a significant study group–by–time interaction over 18 months in diabetes symptoms; anxiety; Medical Outcomes Study Short-Form Health Survey (SF-12) emotional, physical, and pain-related functioning; Sheehan disability; financial situation; and number of social stressors (P = 0.04 for disability and SF-12 physical functioning, P < 0.001 for all others) but no study group–by–time interaction in A1C, diabetes complications, self-care management, or BMI.CONCLUSIONSSocioculturally adapted collaborative depression care improved depression, functional outcomes, and receipt of depression treatment in predominantly Hispanic patients in safety-net clinics.
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