Measurement-Based Care to Enhance Antidepressant Treatment Outcomes in Major Depressive Disorder
Notice bibliographique
Résumé
Importance: Measurement-based care (MBC) guides clinical decisions through structured monitoring of symptoms and adverse effects. Although MBC has been associated with improved outcomes in major depressive disorder (MDD), its effectiveness in low- and middle-income countries (LMICs) remains understudied. Objective: To assess whether MBC accelerates the resolution of depressive symptoms compared with standard care among adults with MDD in Pakistan. Design, Setting, and Participants: This multicenter, assessor-blinded, parallel-arm randomized clinical trial was conducted in Pakistan from September 2022 to January 2024, with 24 weeks of follow-up. Adults diagnosed with nonpsychotic MDD were recruited from psychiatric hospitals and primary care centers in 7 Pakistani cities (Karachi, Lahore, Rawalpindi, Hyderabad, Peshawar, Multan, and Quetta). Participants were randomized 1:1 to MBC or standard care. Intention-to-treat analyses were conducted. Interventions: By design, pharmacotherapy was limited to paroxetine or mirtazapine in both MBC or standard care groups. The MBC group completed the 16-item Quick Inventory of Depressive Symptomatology-Self-Report and the Frequency, Intensity, and Burden of Side Effects Rating Scale at each visit (baseline and weeks 2, 4, 8, 12, and 24). Scores from these instruments informed antidepressant dose adjustments or switch. The standard care group received treatment based on clinician judgment and did not undergo repeated clinical measurements. Main Outcomes and Measures: Primary outcomes were time to response (defined as ≥50% reduction in the 17-item Hamilton Depression Rating Scale [HDRS-17]; range: 0-52, with the highest score indicating severe depression) and time to remission (defined as HDRS-17 score of ≤7) within the 24-week follow-up period. Secondary outcomes included changes in HDRS-17 scores and rates of adverse effects or treatment discontinuation. Results: A total of 154 adults (mean [SD] age, 34.5 [10.5] years; 105 females [68.2%]) were randomized. Median (IQR) time to response was faster with MBC than with standard care (2 [2-4] weeks vs 4 [2-12] weeks); similarly, median (IQR) time to remission was faster for MBC vs standard care (4 [4-8] weeks vs 8 weeks [2 weeks to no remission] weeks). At week 24, there were no significant differences in rates of response or remission between groups. After week 24, reduction in mean HDRS-17 scores was significantly but modestly greater in the MBC group than in the standard care group (-18.1 [95% CI, 16.4-19.6] points vs -17.0 [95% CI, 15.6-18.5] points; t129 = 0.71; P < .001). No differences were observed in other secondary outcomes. Conclusions and Relevance: This trial of adults with MDD found that MBC led to faster time to response and time to remission than standard care in low-resource settings. Future studies need to confirm the clinical effectiveness of MBC and assess its cost-effectiveness in LMICs. Trial Registration: ClinicalTrials.gov Identifier: NCT05431374.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».