Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
Optimism, response to treatment of depression, and rehospitalization after coronary artery bypass graft surgery.
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DOI：
10.1097/psy.0b013e318244903f
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发表时间：
2012-02
影响因子：
3.3
通讯作者：
Rollman BL
中科院分区：
文献类型：
--
作者：
Tindle H;Belnap BH;Houck PR;Mazumdar S;Scheier MF;Matthews KA;He F;Rollman BL
乐观与冠状动脉旁路移植术（CABG）术后再住院的风险较低有关，但对于乐观如何影响CABG术后患者的抑郁治疗知之甚少。利用一项cabg后抑郁的协作护理干预试验的数据，我们对284例cabg后抑郁患者（住院后2周9项患者健康问卷得分≥10）和146例未抑郁的对照组进行了探索性事后分析，这些患者完成了生活取向测试-修订（全量表和亚量表），以评估性格乐观。我们根据样本特定的生活取向测试将患者分为乐观主义者和悲观主义者-每个队列的修订分布（完整样本，抑郁，非抑郁）。在8个月的时间里，我们评估了与健康相关的生活质量（使用36项简短健康调查）和情绪症状（使用汉密尔顿抑郁评定量表[rs - d]），并判定了全因再住院。我们将治疗反应定义为HRS-D评分较基线下降50%或更高。与悲观主义者相比，乐观主义者的基线平均hr - d评分较低（8比15，p = .001）。在抑郁症患者中，乐观主义者更有可能在8个月时对治疗有反应（58%对27%，优势比= 3.02,95%可信区间= 1.28-7.13,p = 0.01），这一发现在干预组中没有得到维持。乐观分量表能预测治疗反应，而悲观分量表不能。到8个月时，乐观主义者再次住院的可能性较小（优势比= 0.54,95%可信区间= 0.32-0.93,p = 0.03）。在cabg术后的抑郁患者中，乐观主义者对抑郁治疗的反应率更高。与抑郁无关，乐观主义者在冠状动脉搭桥术后8个月内再次住院的可能性较小。进一步的研究应该探讨乐观对这些和其他重要的cabg后长期结果的影响。
Optimism has been associated with a lower risk of rehospitalization after coronary artery bypass graft (CABG) surgery, but little is known about how optimism affects treatment of depression in post-CABG patients. Using data from a collaborative care intervention trial for post-CABG depression, we conducted exploratory post hoc analyses of 284 depressed post-CABG patients (2-week posthospitalization score in the 9-item Patient Health Questionnaire ≥10) and 146 controls without depression who completed the Life Orientation Test – Revised (full scale and subscale) to assess dispositional optimism. We classified patients as optimists and pessimists based on the sample-specific Life Orientation Test – Revised distributions in each cohort (full sample, depressed, nondepressed). For 8 months, we assessed health-related quality of life (using the 36-item Short-Form Health Survey) and mood symptoms (using the Hamilton Rating Scale for Depression [HRS-D]) and adjudicated all-cause rehospitalization. We defined treatment response as a 50% or higher decline in HRS-D score from baseline. Compared with pessimists, optimists had lower baseline mean HRS-D scores (8 versus 15, p = .001). Among depressed patients, optimists were more likely to respond to treatment at 8 months (58% versus 27%, odds ratio = 3.02, 95% confidence interval = 1.28–7.13, p = .01), a finding that was not sustained in the intervention group. The optimism subscale, but not the pessimism subscale, predicted treatment response. By 8 months, optimists were less likely to be rehospitalized (odds ratio = 0.54, 95% confidence interval = 0.32–0.93, p = .03). Among depressed post-CABG patients, optimists responded to depression treatment at higher rates. Independent of depression, optimists were less likely to be rehospitalized by 8 months after CABG. Further research should explore the impact of optimism on these and other important long-term post-CABG outcomes.