Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow up?
Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow up?
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DOI：
10.1016/j.jad.2003.11.008
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发表时间：
2004-10-15
影响因子：
6.6
通讯作者：
Gastó, C
中科院分区：
文献类型：
--
作者：
Pintor, L;Torres, X;Gastó, C
背景：对符合《精神障碍诊断与统计手册》第三版修订本（DSM - III - R）单相重性抑郁发作标准的西班牙门诊患者样本进行了超过4年的复发率及复发预测因素研究。
方法：在一项自然观察研究中，对139名门诊患者的最终样本进行每月随访。采用《DSM - III - R结构化临床访谈》。使用汉密尔顿抑郁评定量表并应用弗兰克标准记录病情发展阶段。采用生存分析、卡普兰 - 迈耶乘积极限法和比例风险模型。
结果：部分缓解组的复发率（91.4%）高于完全缓解组（51.3%）。具有复发预测价值的四个因素是：“部分缓解与完全缓解”、“临床症状的严重程度”、“年龄”以及“既往抑郁发作次数”。部分缓解的存在是最有力的预测因素。
局限性：随访期间样本量减少以及难以保证治疗依从性。
结论：从中期来看，重性抑郁发作的复发率较高。抑郁发作后的部分缓解似乎是4年随访中复发的一个重要预测因素。
临床相关性：在4年的随访研究中，未达到完全缓解是复发的一个重要危险因素。（C）2003爱思唯尔公司。版权所有。
Background: Rates of relapse and predictive relapse factors were studied over more than 4 years in a sample of Spanish outpatients with DSM-III-R criteria for unipolar major depressive episode. Methods: A final sample of 139 outpatient was followed monthly in a naturalistic study. The Structured Clinical Interview for DSM-III-R was used. Phases of evolution were recorded using the Hamilton Depression Rating Scale, applying the Frank criteria. Survival analysis, Kaplan-Meier product limit and proportional hazards models were used. Results: A higher rate of relapses was observed in the partial remission group (91.4%) compared to the complete remission one (51.3%). The four factors with predictive relapse value were: "partial remission versus complete remission", "the intensity of clinical symptoms", "the age" and "the number of previous depressive episodes". The existence of partial remission was the most powerful predictive factor. Limitations: The decreasing sample size during the follow-up and the difficulty in warranting the treatment compliance. Conclusions: At medium term, relapse rates for a major depressive episode are high. Partial remission after a depressive episode seems to be an important predictive factor for relapses in a 4-year follow-up. Clinical relevance: Not reaching complete remission is a strong risk factor for relapses in a 4-year follow up study. (C) 2003 Elsevier B.V. All rights reserved.