| Objective The study mainly researches the effectiveness and feasibility ofcooperative community Depression Care Management in China’s urban primary caresettings. In developed countries, patients usually give priority to primary care because itis more convenient than professional medical service and primary physicians can keep along relationship with patients and provide good and sustainable medical services.Currently, primary care is irreplaceable in fields like management of chronic disease,management of elderly patients, home nursing; therefore, our policies on public healthalso energetically popularize and develop primary care. In China, though mental healthhas been involved in the management of community medical care, only patients whosuffer from schizophrenia and mental retardation are concerned currently, which cannotmeet the requirements of community groups to mental health services. Depression is aglobal public health problem we face in the21th century, which not only bring severephysical and mental harms to individuals, but also increase the economic burden onindividuals and countries. Depression has a high clinical cure rate, but only few patientsreceive really diagnosis and treatment according to a world-wide investigation, thisproblem is more serious in our country. Therefore, through introducing foreigncooperative community intervention model and researching it in our urban community,we hope to build a suitable Depression Care Management, which will help bringdepression into chronic disease management, effectively promote its cure rate, lower itsharm in our living quality, physiological and social function, cut suicide rate and reduceconsumption of health resources. Methods The study is divided into two parts, In Study one, we use PHQ-9scaletaking primary test of2,639adult community residents, and280subjects in the2weekslater receive the PHQ-9and the SCID psychiatric diagnosis and HRSD evaluation. InStudy two,16primary care clinics are randomly divided into experimental group andcontrol group in half. After PHQ-9screening and psychiatric diagnosis,134and136subjects are enrolled into two groups respectively. The experimental group receive themanagement of DCM mode, and the control group had no interventions. The finally,two groups have114and113subjects respectively completed the6-month follow-upvisit.Results Through a6-month follow-up visit and control study of DCM to elders inprimary who with depressed, we draw the following results:1) In the study, we used PHQ-9as the screening tool of depression. In earlier stage, wesurveyed2,639community residents, which indicated that the Cronbach’s alpha ofPHQ-9was0.89and its sensitivity and specificity were87%and81%respectively. Inaddition, the combination of sensitivity and specificity reached optimum at thedemarcation point of a10point critical value when PHQ-9was used as the screeningtool according to the measuring points. Therefore, PHQ-9is still can be used in latercontrol studies.2) Through the data analysis to the6-month follow-up visit, we found the depressivesymptoms of patients in experimental group reduced significantly compared with thecontrol group; the living quality of patients in experimental group also get improved;also we found that patients in experimental group and control group both decreasedtheir discrimination and resistance to depression and for the former, the decrease wasmore significant. Conclusion To sum up, it is proved that DCM mode is feasible and effective in themanagement of depression in urban primary care settings. It can improve the relevancerate and cure rate of elder people who suffer from depression, reduce depressivesymptoms, improve life quality, decrease the discrimination to mental illness,popularize mental hygienic knowledge and strengthen people’s attention and cognitionto mental problems. |
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