The effect of depression on the decision to join a clinical trial.
The effect of depression on the decision to join a clinical trial.
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DOI：
10.1037/ccp0000212
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发表时间：
2017-07
影响因子：
5.9
通讯作者：
Muñoz RF
中科院分区：
文献类型：
--
作者：
Leykin Y;Dunn LB;Muñoz RF
临床试验是评价新疗法的必要条件。然而，人们开始关注抑郁症患者在参加临床试验时的脆弱性，也就是说，他们在参加临床试验时做出正确决定的能力。本研究的目的是通过比较三组患者的决定，确定抑郁症是否会影响参加临床试验的决定：抑郁症患者、患有慢性疼痛的患者和同时患有抑郁症和慢性疼痛的患者。参与者（抑郁症61例，慢性疼痛60例，合并症58例）通过临床访谈完成了判断和决策领域的常见决策任务（时间权衡和标准赌博）。决策的合理性定义为对其健康的评价与参与者为改善健康而愿意接受的风险程度之间的一致性。抑郁症患者比慢性疼痛患者做出更少的理性决定（部分eta2= 0.075, 90%CI: 0.009 -）。180)，然而，这种差异是在风险厌恶的方向上，这表明抑郁症患者对临床试验的参与过于谨慎。此外，这种风险厌恶不仅局限于抑郁症的临床试验，还扩展到慢性疼痛的临床试验（部分eta2= 0.041, 90%CI: 0.002 -）。117)，这表明抑郁症患者在更广泛的健康选择上可能过于谨慎。我们的研究结果表明，对抑郁症患者做出过于冒险的“绝望”决定的担忧可能是没有根据的，更有可能的是，抑郁症患者可能会放弃有价值的护理选择，以试图避免风险。
Clinical trials are necessary for evaluation of novel treatments. However, concerns have been raised about the vulnerability of depressed individuals when joining clinical trials, that is, about their abilities to make good decisions about clinical trial participation. The purpose of this study was to determine whether depression compromises decisions to join clinical trials, by comparing the decisions of three groups: depressed individuals, individuals suffering from chronic pain, and individuals with comorbid depression and chronic pain. Participants (depressed: n=61; chronic pain: n=60; comorbid: n=58) completed, via a clinical interview, common decision-making tasks from the field of judgment and decision-making (time trade-off and standard gamble). The rationality of decisions was defined as the concordance between the evaluations of their health and the amount of risk participants would accept to improve health. Depressed individuals made less rational decisions than individuals with chronic pain (partial eta2=.075, 90%CI:.009–.180), however, the discrepancy was in the direction of risk aversion, suggesting that depressed individuals were overly cautious about clinical trial participation. Further, this risk aversion was not limited to clinical trials for depression, but also extended to clinical trials for chronic pain (partial eta2=.041, 90%CI:.002–.117), suggesting that depressed individuals may be overly cautious in their health choices more broadly. Our findings suggest that concerns about depressed individuals making overly risky “desperate” decisions is likely unfounded, and it is more likely that depressed individuals may forgo valuable care options in an attempt to avoid risk.