ABSTRACT
Introducción. Se emplea el modelo biopsicosocial de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF) para: a) estudiar el perfil de funcionamiento en depresión unipolar tratada en atención primaria; b) determinar variables predictoras y mediadoras de discapacidad en depresión, y c) analizar la eficacia del tratamiento psicofarmacológico habitual en la remisión funcional de pacientes con depresión. Diseño. Naturalístico, longitudinal, prospectivo. Emplazamiento. Estudio multicéntrico en atención primaria. Centros del Área 2 de la Comunidad de Madrid. Participantes. Pacientes adultos con diagnóstico de depresión unipolar que inician tratamiento con inhibidores selectivos de la recaptación de serotonina en centros de atención primaria. Se excluirán los pacientes con historia de trastorno bipolar, trastornos psicóticos, demencias y con historia de dependencia de sustancias adictivas. Medidas principales. Nivel de discapacidad en distintas áreas de funcionamiento evaluado con instrumentos desarrollados a partir de la CIF. Sucesos vitales estresantes, apoyo social y esquemas cognitivos serán explorados como variables mediadoras del funcionamiento. Características sociodemográficas y clínicas y el tratamiento psicofarmacológico son tratados como factores independientes. Discusión y aplicabilidad clínica. Sesgo en la representatividad y selección de la muestra podrían afectar a la generalización de resultados. Se aplica por primera vez en España el modelo biopsicosocial de la CIF y la metodología desarrollada en el estudio de la depresión en atención primaria. Se espera una mejor comprensión de factores ligados a discapacidad funcional en pacientes con depresión. El proyecto se suma a una de las líneas prioritarias de investigación en la UE (proyecto MHADIE)
Introduction. We use the biopsychosocial model of the International Classification of Functioning, Disability, and Health (ICF): a) to analyze functioning and disability patterns in unipolar depression cases attended in primary care settings; b) to study predictive and mediator variables related to disability in depression, and c) to determine the impact of traditional interventions in depression cases using functional remission as outcome measure. Design. Naturalistic, prospective, longitudinal. Setting. Multicenter study in primary care. Health Area 2. Region of Madrid. Participants. Adult patients with a diagnosis of unipolar depression who initiate psychopharmacological treatment with selective serotonin reuptake inhibitor (SSRI) in primary care sites. Patients with history of bipolar disorders, psychotic disorders, dementias, and dependence of toxic substances will be excluded. Main measurements. Level of functioning and disability in different domains of well-being assessed through ICF related instruments. Stressful life events, social support and cognitive schemes will be analyzed as mediator variables. Socio-demographic and clinical characteristics, psychopharmacological treatment and treatment compliance are considered independent factors. Discussion and practical use. Selection bias may affect the generalization of the results. The biopsychosocial model underlying the ICF and its methodology are applied to the study of depression in primary care settings for the first time in Spain. Improving our understanding of disability related factors in depressive patients is expected. This study is one of the main research priorities of the EU (MHADIE project)
Subject(s)
Humans , Depressive Disorder/psychology , Psychometrics/instrumentation , Primary Health Care/statistics & numerical data , Depressive Disorder/complications , Disability Evaluation , Multicenter Studies as Topic , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
INTRODUCTION: We use the biopsychosocial model of the International Classification of Functioning, Disability, and Health (ICF): a) to analyze functioning and disability patterns in unipolar depression cases attended in primary care settings; b) to study predictive and mediator variables related to disability in depression, and c) to determine the impact of traditional interventions in depression cases using functional remission as outcome measure. DESIGN: Naturalistic, prospective, longitudinal. SETTING: Multicenter study in primary care. Health Area 2. Region of Madrid. PARTICIPANTS: Adult patients with a diagnosis of unipolar depression who initiate psychopharmacological treatment with selective serotonin reuptake inhibitor (SSRI) in primary care sites. Patients with history of bipolar disorders, psychotic disorders, dementias, and dependence of toxic substances will be excluded. MAIN MEASUREMENTS: Level of functioning and disability in different domains of well-being assessed through ICF related instruments. Stressful life events, social support and cognitive schemes will be analyzed as mediator variables. Socio-demographic and clinical characteristics, psychopharmacological treatment and treatment compliance are considered independent factors. DISCUSSION AND PRACTICAL USE: Selection bias may affect the generalization of the results. The biopsychosocial model underlying the ICF and its methodology are applied to the study of depression in primary care settings for the first time in Spain. Improving our understanding of disability related factors in depressive patients is expected. This study is one of the main research priorities of the EU (MHADIE project).
