| Titre : | Treating depression in primary care in low-income women in Santiago, Chile : a randomised controlled trial. (2003) |
| Auteurs : | Ricardo ARAYA ; Rosemarie FRITSCH ; Jorge GAETE ; Tim-J Peters ; Graciela ROJAS ; Maritza ROJAS ; Greg Simon ; Hospital Clinico. Facultad de Medicina. Universidad de Chile. Santiago. CHL |
| Type de document : | Article |
| Dans : | Lancet (The) (vol. 361, n° 9362, 2003) |
| Pagination : | 995-1000 |
| Langues: | Anglais |
| Mots-clés : | Etat dépressif ; Homme ; Femme ; Soins santé primaire ; Chili ; Amérique ; Thérapeutique ; Programme santé ; Pauvreté ; Trouble humeur ; Amérique du Sud |
| Résumé : | [BDSP. Notice produite par INIST-CNRS zR0xA556. Diffusion soumise à autorisation]. Background Depression in women is one of the commonest problems encountered in primary care. We aimed to compare the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Santiago, Chile. Methods In a randomised controlled trial, in three primary-care clinics in Chile, 240 adult female primary-care patients with major depression were allocated stepped care or usual care. Stepped care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. Data were analysed on an intention-to-treat basis. The primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation. Findings About 90% of randomised patients completed outcome assessments. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. The adjusted difference in mean HDRS score between the groups was - 8.89 (95% Cl - 11.15 to - 6.76 ; p<0.0001). At 6-months'follow-up, 70% (60-79) of the stepped-care compared with 30% (21-40) of the usual-care group had recovered (HDRS score<8). Interpretation Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme, which is being introduced across Chile. Socially disadvantaged patients might gain the most from systematic improvements in treatment of depression. |
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