Distress and anhedonia as predictors of depression treatment outcome: A secondary analysis of a randomized clinical trial
Distress and anhedonia as predictors of depression treatment outcome: A secondary analysis of a randomized clinical trial
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DOI：
10.1016/j.brat.2019.103507
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发表时间：
2020-02-01
影响因子：
4.1
通讯作者：
Hollon, Steven D.
中科院分区：
文献类型：
--
作者：
Khazanov, Gabriela K.;Xu, Colin;Hollon, Steven D.
抑郁症的两个核心特征包括情绪低落(忧郁加剧)和快感缺失(快感降低)。尽管它们是抑郁症的核心，但在一项提供抗抑郁药物(ADM)和认知疗法(CT)等主流治疗的随机临床试验中，研究还没有检查它们对治疗结果的贡献。我们使用情绪和焦虑症状问卷的因素分析得出的基线痛苦和快感缺乏来预测433名复发性/慢性重度抑郁障碍患者的缓解和康复。患者仅给予ADM或同时给予ADM和CT。总体而言，较高的基线痛苦和快感缺乏预示着一年内缓解和三年内恢复的时间更长。在控制治疗条件时，苦恼改善了对快感缺乏以上结果的预测，而快感缺乏并不能改善对苦恼以上结果的预测。与治疗条件的相互作用表明，有较高苦恼和快感缺乏的个体在接受ADM的同时接受CT治疗，而对于较低苦恼和快感缺乏的个体，CT没有额外的好处。在治疗前评估痛苦和快感缺乏可能有助于选择除了ADM外，从CT中受益最大的患者。对于被测试的治疗和结果衡量标准，利用痛苦来指导治疗计划可能会产生最大的好处。
Two core features of depression include depressed mood (heightened distress) and anhedonia (reduced pleasure). Despite their centrality to depression, studies have not examined their contribution to treatment outcomes in a randomized clinical trial providing mainstream treatments like antidepressant medications (ADM) and cognitive therapy (CT). We used baseline distress and anhedonia derived from a factor analysis of the Mood and Anxiety Symptom Questionnaire to predict remission and recovery in 433 individuals with recurrent/chronic major depressive disorder. Patients were provided with only ADM or both ADM and CT. Overall, higher baseline distress and anhedonia predicted longer times to remission within one year and recovery within three years. When controlling for treatment condition, distress improved prediction of outcomes over and above anhedonia, while anhedonia did not improve prediction of outcomes over and above distress. Interactions with treatment condition demonstrated that individuals with higher distress and anhedonia benefited from receiving CT in addition to ADM, whereas there was no added benefit of CT for individuals with lower distress and anhedonia. Assessing distress and anhedonia prior to treatment may help select patients who will benefit most from CT in addition to ADM. For the treatments and outcome measures tested, utilizing distress to guide treatment planning may yield the greatest benefit.