Prevalence Of Major Depressive Disorder In Non-psychiatric Prevalence Of Major Depressive Disorder In Non-psychiatric Trial Of Telephone Vs.face-to-face Cognitive Behavioral Therapy

Background:Major depressive disorder(MDD)has become a tremendous source of global disease burden.Patients with depressive disorder of-ten suffer from physical discomfort,resulting in a great deal of patients first visiting a non-psychiatric clinic in general hospitals.However,there are few large samples in China that report the prevalence of MDD in non-psychotic patients in general hospitals.Even if the diagnosis of MDD is clear,it is extremely difficult to treat.Although there are many varieties of antidepressants,the individual differences are obvious.Even if the antidepressant is effective,the patients who take the drug for a long time are worried about the side effects of the drug.Depressive patients in the world needs to face this dilemIIma,so people are eager to find an effective non-drug therapy to help them get out of trouble.Cognitive Behavioral Therapy(CBT)has been included in many countries as a primary or adjunct to the treatment of depression.There are many forms of CBT.At present,face-to-face CBT is more commonly used.However,due to face-to-face CBT has barriers of time,region,stigma,it has been restricted from development and promotion.With the development of science and technology,telemedicine(telephone-delivered CBT)has entered people's field of vision.What is the effect of telephone-delivered CBT?Foreign studies have different opinions respectively.Domestic researchers have used telephone CBT to treat insomnia,but no one has reported the efficacy of applying telephone-delivered CBT to moderate or severe MDD.Objective:Firstly,the prevalence of MDD in the non-psychiatric outpatient clinics ofthe multi-center general hospital was investigated,and its clinical features(focusing on Ssuicidal ideation)were explored.Secondly.the clinical efficacy of telephone-delivered CBT and non-inferiority analysis compared with face-to-face CBT were explored.Method:Questionnaires were used in non-psychiatric outpatient clinics in four general hospitals.A total of 5,284 people were screened,5,189 completed the Patient Health Questionnaire 9(PHQ-9),1392 people PHQ-9>5(recommended for psychiatric interviews),and finally 819 accepted psychiatric interviews.190 people were diagnosed with MDD.Recruited by cross-sectional survey(9 enrolled),referral of clinicians and new media recruitment of moderate to severe MDD patients(61 enrolled),a total of 70 participants,then they joined in randomized controlled single-blind intervention study,that is drugs + face-to-face CBT or telephone CBT,All of patients had signed a written informed consent forI1m.Result:In the cross-sectional study,the prevalence of major depressive disorder in late in the recent month in the 5189 sample was 3.7%,and 2.3%of patients had suicidal ideation.In the randomized controlled trial.70 patients with moderate to severe MDD had a shedding rate of 5.7%,71.4%had higher education at the university level,and 41.4%preferred long-distance psychotherapy.The comorbidity rate of mental disorders was as high as 84.3%,and the generalized anxiety disorder accounted for 74.3%.After intervention,the non-inferiority analysis of the clinical features of the telephone CBT and face-to-face CBT groups showed that they were not inferior to face-to-face CBT in relieving depression,anxiety symptoms,improving general function and improving quality of life(phone CBT group PHQ-9 total score(A value?2.18,p value = 0.01),HAMA total score(A value = 2.76,p value = 0.02),GAD-7 total score(A value = 2.18,p value = 0.01),GAF total score(A value = 6.62,p value=0.03),non-inferiority analysis of PCS total score(A value = 3.07,p value = 0.04)at the 6th month follow-up suggestion:telephone CBT compared to face-to-face CBT group The total scores of 17-HAMD,HAMA,GAD-7 and DAS in the group were statistically significant:17-HAMD correction score(A value = 1.75,p value = 0.02),HAMA correction score(? value 1 1.86,p value = 0.00),GAD-7 correction score(?value = 4.52,P value = 0.04),DAS correction score(A value = 3.47.P value = 0.02).The above results indicate that the telephone CBT group was followed at 6 months.Depression,anxiety relief and poor cognitive function correction are not inferior to face-to-face CBT group.At 0.12 months follow-up,it 1s not difficult to correct cognitive bias and improve quality of life.CBT face(DAS dysfunctional attitudes Questionnaire points:? value = 4.25,p-value = 0.026;Medical Outcomes Study Short Version PCS-12 somatic division factor:? value = 2.71,p-value = 0.015).Conclusion:Outpatients attending general hospital non-psychiatric clinics are at high risk for MDD.Clinical physicians should have the awareness of screening,identification,and referral to ensure that patients receive individualized and quality medical services.Telephone-delivered CBT has a good effect in relieving depression,anxiety symptoms,correcting distortion cognition,improving quality of life,and improving global function,and is no inferior than face-to-face CBT in many clinical features.Telephone-delivered CBT has the advantages of convenience,easy to promote and long-lasting effect.It has great potential in the medical service system and is worthy of attention and promotion by clinicians and researchers.