engleski

Liječenje subsindromalne depresije: kratkoročni rezultati randomizirane kontrolirane usporedbe psihoedukacije, tjelesne aktivnosti i uobičajenog liječenja

Aim: The study aimed to explore the short-term effects of psychoeducation or physical exercise versus treatment as usual in T2DM patients reporting subclinical depressive symptoms. Primary outcomes included changes in depressive symptoms, and secondary outcomes were changes in diabetes- related distress, diabetes self-care activities, health-related quality of life and metabolic variables. Methods: Participants (N = 175, 55% female, aged 60±3 yrs, with diabetes duration of 11.6±7.9 yrs, 40.1% insulin-treated, with BMI of 29.7±4.3 kg/m2, and HbA1C of 7.3%±1.1) were randomly assigned to a psychoeducational intervention (n=64), physical exercise intervention (n=52), or diabetes treatment as usual (n=59). Participants who reported depressive symptoms in a postal screen (PHQ-2) were interviewed by telephone to collect sociodemographic data and establish the presence of exclusion criteria (major depressive disorder, history of severe mental illness, physical limitations). Eligible patients were invited to the clinic to give informed consent, attend a medical examination and provide psychological data and blood samples. Baseline assessments of depressive symptoms, diabetes-related distress, diabetes self-care activities and health-related quality of life were collected using the CES-D, PAID, DSCA, and SF-12, respectively. Metabolic parameters included HbA1c, total cholesterol, LDL, HDL, and triglycerides. The same psychological and biochemical measures were repeated after the completion of the interventions, i.e. eight weeks after baseline. In addition, the participants’ assessments of their satisfaction with treatment were collected using the modified Patient Enablement Inventory (PEI). The psychoeducation and physical activity interventions comprised 6 interactive small-group sessions. Each session included a short lecture and an interactive part (homework review, exercise). The patients in the control arm were informed about available options for depression treatment, and participated in a 1-hour small- group diabetes re-education. Repeated measures ANOVAs were used to determine differences within and between the three groups in the week after the intervention period (8 weeks after the baseline measurements). Results: Eight weeks after the baseline, all groups improved in depression symptoms (F = 42.39, p < 0.001), diabetes-related distress (F = 22.58, p < 0.001), all aspects of self-care (p < 0.05), as well as mental health (F = 15.22, p < 0.001), emotional roles (F = 11.82, p = 0.001) and social functioning (F = 4.00, p=0.047). The only between- group difference was found for SMBG, but post-hoc testing did not detect discrete differences between the three groups. Perceived enablement to self-manage mood and diabetes at follow-up was higher in both intervention groups than in the control group (p < 0.05). Glycemic control (F = 9.73, p = 0.02), total cholesterol (F = 12.09, p = 0.001), and LDL-cholesterol (F=5.35, p=0.022) at follow up were improved in all study groups, while HDL-cholesterol decreased in all groups (F = 5.70, p = 0.018). Conclusion: Although improvements in psychological and metabolic outcomes were observed at the 8-week follow-up, the effects of interventions did not differ from the control condition. There are two hypothetical explanations for the absence of between-group differences: either non-specific support may have operated more strongly than specific treatment effects, or other methodological or disease-related reasons may have confounded the results. This issue remains to be clarified in the 6- and 12-month follow-up.

subsyndromal depression; diabetes; psychoeducation

nije evidentirano