Barceló Soler, Alberto
López del Hoyo, Yolanda (dir.) ; García Campayo, Javier (dir.)
Universidad de Zaragoza,
2020
Resumen: La depresión es un problema de salud pública en todo el mundo reconocido por la OMS, cuya prevalencia en los servicios de Atención Primaria se estima en 19,5% a nivel mundial, y en 20% en España. Debido a la necesidad de diseñar nuevas estrategias terapéuticas que permitan hacer frente a este problema, en los últimos años se ha venido desarrollado una línea de investigación dirigida a la creación y evaluación de protocolos de intervención psicológica aplicados a través de las Tecnologías de la Información y la Comunicación, y especialmente las realizadas a través de internet. De hecho, la literatura científica disponible sugiere que estos tratamientos pueden ser alternativas eficaces para el tratamiento de la depresión. Por otro lado, las terapias de tercera generación, y concretamente las intervenciones basadas en mindfulness, han mostrado ser efectivas para el tratamiento de diferentes psicopatologías. Sin embargo, apenas se cuenta con estudios científicos llevados a cabo en España, en los que se evalúen programas de psicoterapia por ordenador para la depresión, en el ámbito de Atención Primaria. El objetivo principal de esta tesis es evaluar la eficacia de un protocolo de intervención psicológica breve basada en mindfulness y aplicada a través de internet para el tratamiento de la depresión leve-moderada, dentro del contexto sanitario español de Atención Primaria. El estudio de investigación que se presenta fue un ensayo clínico multicéntrico controlado y aleatorizado en dos grupos paralelos. Los pacientes con depresión leve o moderada, incluidos en el estudio, fueron asignados al azar entre las dos condiciones experimentales: a) tratamiento breve de psicoterapia por ordenador basado en mindfulness + tratamiento habitual mejorado (mindfulness + iTAU); b) tratamiento habitual mejorado (iTAU). La gravedad de la depresión, variable principal del estudio, se evaluó con el cuestionario sobre la salud del paciente, por sus siglas en inglés PHQ-9. Además, también se recogieron las siguientes variables: calidad de vida (SF-12), afecto positivo y negativo (PANAS); mindfulness (FFMQ); y bienestar (PHI). Las medidas de evaluación se llevaron a cabo en el pre-tratamiento (momento 1), en el post-tratamiento (momento 2), a los 6 meses (momento 3) y 12 meses del post-tratamiento (momento 4). Finalmente, de los 111 pacientes reclutados, 54 fueron asignados al grupo mindfulness y 57 al grupo control. El tratamiento breve de psicoterapia por ordenador basado en mindfulness mostró mejoras significativas en la gravedad de depresión, en comparación al grupo control, al finalizar el tratamiento (p = 0,001). Sin embargo, estas diferencias no se mantuvieron a los 6 meses de seguimiento, puesto que los sujetos de ambos grupos experimentaron el mismo perfil de mejoría en esta variable. Para las variables afecto negativo y calidad de vida mental se observó un patrón similar al seguido por la depresión, de manera que las diferencias halladas en el post-tratamiento no se mantenían en el seguimiento a los 6 meses. Por otro lado, las variables que mejor predecían una mejora en el nivel de depresión fueron: nivel de estudios, sexo, contrato de trabajo, tiempo de tratamiento, y días de repaso antes del post-test. La principal conclusión extraída a partir de los resultados obtenidos del estudio, es que el protocolo de intervención psicológico breve basado en mindfulness y aplicado a través de internet es eficaz, a corto plazo, en la mejora de la sintomatología depresiva leve-moderada, y que podría ser una adecuada estrategia de prevención secundaria en el ámbito de Atención Primaria de España.
Abstract:
Depression is, nowadays, a global health problem recognized by the World Health Organization. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. Due to the need to create new therapeutic strategies to address this problem, a line of research has been developed in recent years, whose objective is creating and evaluating psychological intervention protocols applied through Information and Communication Technologies, and especially those applied over the Internet. In fact, scientific literature suggests that these treatments may be effective alternatives for the treatment of depression. On the other hand, third generation therapies, and specifically mindfulness-based interventions, have been proven effective for the treatment of different psychopathologies. However, there is an absence of scientific studies carried out in Spain in which computer psychotherapy programs are evaluated for depression in Primary Care. The main objective of this thesis is to evaluate the efficacy of a brief psychological mindfulness-based intervention applied through the internet for the treatment of mild-moderate depression in Spanish Primary Care. A multicenter, two-arm, parallel, randomized controlled trial was carried out. Participants were randomized into two experimental conditions: a) brief online mindfulness-based intervention + improved usual treatment (mindfulness + iTAU); b) improved usual treatment (iTAU). The main outcome of the study was depression, which was evaluated with the Patient Health Questionnaire (PHQ-9). In addition, the following variables were also evaluated: quality of life (SF-12), positive and negative affect (PANAS); mindfulness (FFMQ); and well-being (PHI). The evaluations were collected from the pre-treatment (time 1) to the post-treatment (time 2), and up to 6 (time 3) and 12 months (time 4) follow up. Finally, of the 111 patients recruited, 54 were assigned to the mindfulness group and 57 to the control group. The mindfulness intervention showed significant improvements in the severity of depression compared to control at post-treatment (p = 0,001). However, these differences were not maintained at time 3, since both groups’ participants experienced the same improvement profile regarding this variable. For the negative affect and mental quality of life, the pattern was similar to that followed by depression, so that the differences found in the post-treatment were not maintained in the 6-month follow-up. On the other hand, the variables that best predicted an improvement in the depression levels were: level of studies, sex, employment contract, treatment time, and days of revision before the post-test. The main conclusion of the study is that the brief online mindfulness-based intervention is effective in the short term in the improvement of mild-moderate depressive symptomatology, and that it could be an appropriate secondary prevention strategy in the context of Spanish Primary Care.
Resumen (otro idioma):
Abstract:
Depression is, nowadays, a global health problem recognized by the World Health Organization. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. Due to the need to create new therapeutic strategies to address this problem, a line of research has been developed in recent years, whose objective is creating and evaluating psychological intervention protocols applied through Information and Communication Technologies, and especially those applied over the Internet. In fact, scientific literature suggests that these treatments may be effective alternatives for the treatment of depression. On the other hand, third generation therapies, and specifically mindfulness-based interventions, have been proven effective for the treatment of different psychopathologies. However, there is an absence of scientific studies carried out in Spain in which computer psychotherapy programs are evaluated for depression in Primary Care. The main objective of this thesis is to evaluate the efficacy of a brief psychological mindfulness-based intervention applied through the internet for the treatment of mild-moderate depression in Spanish Primary Care. A multicenter, two-arm, parallel, randomized controlled trial was carried out. Participants were randomized into two experimental conditions: a) brief online mindfulness-based intervention + improved usual treatment (mindfulness + iTAU); b) improved usual treatment (iTAU). The main outcome of the study was depression, which was evaluated with the Patient Health Questionnaire (PHQ-9). In addition, the following variables were also evaluated: quality of life (SF-12), positive and negative affect (PANAS); mindfulness (FFMQ); and well-being (PHI). The evaluations were collected from the pre-treatment (time 1) to the post-treatment (time 2), and up to 6 (time 3) and 12 months (time 4) follow up. Finally, of the 111 patients recruited, 54 were assigned to the mindfulness group and 57 to the control group. The mindfulness intervention showed significant improvements in the severity of depression compared to control at post-treatment (p = 0,001). However, these differences were not maintained at time 3, since both groups’ participants experienced the same improvement profile regarding this variable. For the negative affect and mental quality of life, the pattern was similar to that followed by depression, so that the differences found in the post-treatment were not maintained in the 6-month follow-up. On the other hand, the variables that best predicted an improvement in the depression levels were: level of studies, sex, employment contract, treatment time, and days of revision before the post-test. The main conclusion of the study is that the brief online mindfulness-based intervention is effective in the short term in the improvement of mild-moderate depressive symptomatology, and that it could be an appropriate secondary prevention strategy in the context of Spanish Primary Care.
Resumen (otro idioma):
Pal. clave: psicologia clinica ; psiquiatria ; ciencias clinicas ; ciencias medicas
Titulación: Programa de Doctorado en Medicina
Plan(es): Plan 497
Departamento: Medicina, Psiquiatría y Dermatología
Nota: Presentado: 20 02 2020
Nota: Tesis-Univ. Zaragoza, Medicina, Psiquiatría y Dermatología, 2020
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Registro creado el 2020-06-08, última modificación el 2021-05-20
