初级保健心理治疗服务对治疗英国成人自闭症患者抑郁和焦虑的有效性：一项针对国家医疗保健记录的回顾性、匹配、观察性队列研究

Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records

<The Lancey - Psychiatry> 2023, 10 (12)

【摘要】背景：自闭症成人报告的焦虑和抑郁患病率高于未确诊自闭症的成人，但获得适当心理保健的机会较少。成人自闭症治疗指南推荐循证心理疗法，但尚无研究调查其在代表接受常规护理的自闭症人群的大样本中的有效性。本研究旨在检查初级保健服务中自闭症成人的治疗结果。方法：在这项针对国家医疗保健记录的回顾性、匹配、观察性队列研究中，我们使用了MODIFY数据集，该数据集使用链接的电子医疗保健记录（包括国家数据），针对在初级保健中接受心理治疗的个人，《改善心理治疗的可及性》（IAPT）在英国英格兰的211个临床调试小组区域提供服务。所有在 2012-2019年完成IAPT课程的18岁或以上成年人均符合资格，并且与未发现自闭症的对照组进行倾向评分匹配 (1:1)。在可能的情况下，对一系列社会人口因素进行了精确匹配。主要结果是国家定义并用于评估IAPT治疗的常规指标：可靠的改善、可靠的恢复和可靠的恶化。次要结果是计算患者健康问卷-9、广泛性焦虑症评估-7以及工作和社会适应量表测量的治疗前后评分变化。亚组分析调查了一系列社会人口因素的差异影响。发现：在2012-19年至少完成两次IAPT的2,515, 402名成年人中，8761人被诊断为自闭症（5054 [57·7%] 男性和3707 [42·3%] 女性），1,918,504人没有（631,606 [32·9%] 男性和1,286,898 [67·0%] 女性）。经过倾向评分匹配后，8593名自闭症患者与对照组中的一名患者进行了匹配。在IAPT治疗期间，大多数自闭症成人的抑郁和广泛性焦虑症症状有所减轻，但自闭症组的症状改善的可能性低于对照组（8593名自闭症成人中，有4820名 [56·1%] 得到了可靠的改善，而5304名成人则有可靠的改善）匹配组中8593名成年人中的 [61·7%]；调整后的比值比 [ORadj] 0·75，95% CI 0·70–0·80；p<0·0001）并且症状更有可能恶化（792 [9·2%] 对比619 [7·2%]；ORadj 1·34、1·18–1·48；p<0·0001）。在对照组中，结果的改善与就业有关，属于较高的社会经济剥夺类别，但自闭症成人的情况并非如此。解释: 针对抑郁或焦虑的循证心理治疗可能对患有自闭症的成年人有效，但不如未确诊自闭症的成年人有效。对于自闭症患者来说，治疗调节因素似乎有所不同，因此需要进行更多研究来提供更有针对性和个性化的护理。

[Abstract] Background:  Autistic adults report a higher prevalence of anxiety and depression than adults without identified autism but have poorer access to appropriate mental health care. Evidence-based psychological therapies are recommended in treatment guidelines for autistic adults, but no study has investigated their effectiveness in large samples representative of the autistic population accessing routine care. This study aimed to examine therapy outcomes for autistic adults in a primary care service. Methods: In this retrospective, matched, observational cohort study of national health-care records, we used the MODIFY dataset that used linked electronic health-care records, including national data, for individuals who accessed psychological therapy in primary care in Improving Access to Psychological Therapies (IAPT) services in 211 clinical commissioning group areas in England, UK. All adults aged 18 years or older who had completed a course of IAPT in 2012–19 were eligible, and were propensity score matched (1:1) with a comparison group without identified autism. Exact matching was used, when possible, for a range of sociodemographic factors. Primary outcomes were routine metrics that have been nationally defined and used to evaluate IAPT treatments: reliable improvement, reliable recovery, and reliable deterioration. Secondary outcomes were calculated pre–post treatment changes in scores for Patient Health Questionnaire-9, Generalised Anxiety Disorder Assessment-7, and Work and Social Adjustment Scale measures. Subgroup analyses investigated differential effects across a range of sociodemographic factors. Findings: Of 2,515,402 adults who completed at least two sessions of IAPT in 2012–2019, 8761 had an autism diagnosis (5054 [57·7%] male and 3707 [42·3%] female) and 1,918,504 did not (631 606 [32·9%] male and 1,286,898 [67·0%] female). After propensity score matching, 8593 autistic individuals were matched with an individual in the comparison group. During IAPT treatment, symptoms of depression and generalised anxiety disorder decreased for most autistic adults, but symptoms were less likely to improve in the autism group than in the comparison group (4820 [56·1%] of 8593 autistic adults had reliable improvement vs 5304 [61·7%] of 8593 adults in the matched group; adjusted odds ratio [ORadj] 0·75, 95% CI 0·70–0·80; p<0·0001) and symptoms were more likely to deteriorate (792 [9·2%] vs 619 [7·2%]; ORadj 1·34, 1·18–1·48; p<0·0001). In the comparison group, improved outcomes were associated with employment and belonging to a higher socioeconomic deprivation category, but this was not the case for autistic adults. Interpretation: Evidence-based psychological therapy for depression or anxiety might be effective for autistic adults but less so than for adults without identified autism. Treatment moderators appear different for autistic individuals, so more research is needed to allow for better targeted and personalised care.

论文原文：Céline El Baou, Georgia Bell, Rob Saunders, Joshua E J Buckman, William Mandy, Dave Dagnan, et al. (2023). Effectiveness of primary care psychological therapy services for treating depression and anxiety in autistic adults in England: a retrospective, matched, observational cohort study of national health-care records. The Lancey - Psychiatry. 10 (12): 944-954.

https://doi.org/10.1016/S2215-0366(23)00291-2

（需要英文全文的朋友，请联系微信：millerdeng95）