Depression Sudden Gains and Transient Depression Spikes During Treatment for PTSD
Depression Sudden Gains and Transient Depression Spikes During Treatment for PTSD
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DOI：
10.1037/a0035286
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发表时间：
2014-02-01
影响因子：
5.9
通讯作者：
Zoellner, Lori A.
中科院分区：
文献类型：
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作者：
Keller, Stephanie M.;Feeny, Norah C.;Zoellner, Lori A.
目的：我们对创伤后应激障碍（PTSD）治疗期间抑郁症状的变化如何展开，或者患者特征如何预测抑郁症状的变化知之甚少。本研究探讨了PTSD治疗过程中抑郁症状的关键转变点，即抑郁突然获得，这是快速的症状改善和短暂的抑郁尖峰，这是短暂的抑郁发作。社会支持是PTSD发展的最强预测因子之一，被认为是抑郁症状不连续性的预测因子。方法：在治疗前，200名参与者（76.6%女性; 64.9%白人;年龄M = 37.1，SD = 11.3岁）完成了PTSD严重程度（PTSD症状量表自我报告），抑郁严重程度（贝克抑郁量表），一般社会支持（社会支持行为量表;社会支持问卷）和创伤相关社会支持（社会反应问卷）的测量。在10周的长期暴露（PE）或舍曲林，抑郁症每周进行评估。结果：总体而言，18.0%的参与者经历了抑郁突然增加，22.5%经历了短暂的抑郁尖峰。抑郁突然增加的存在预测更好的治疗结局，β =-4.82，SE = 1.17，p = 0.001，95% CI [-6.79，-2.90]。较高的负面创伤相关反应的感知，虽然适度，与经历短暂的抑郁尖峰（r = 0.18，p = 0.01）。治疗组之间的抑郁突然增加或短暂性抑郁峰值的发生率没有差异。结论：令人鼓舞的是，抑郁症状的快速改善有利于PTSD的治疗结果，但抑郁症状的短暂高峰不会强烈影响结果。了解症状的不连续性可以帮助我们个性化目前的PTSD治疗方案。
Objective: We know little about how change unfolds in depression symptoms during posttraumatic stress disorder (PTSD) treatment or how patient characteristics predict depression symptom change. This study examined critical transition points in depression symptoms during PTSD treatment, namely, depression sudden gains, which are rapid symptom improvements and transient depression spikes, which are transient depression worsenings. Social support, one of the strongest predictors of PTSD development, was examined as a predictor of depression symptom discontinuities. Method: At pretreatment, 200 participants (76.6% female; 64.9% Caucasian; age M = 37.1, SD = 11.3 years) completed measures of PTSD severity (PTSD Symptom Scale-Self-Report), depression severity (Beck Depression Inventory), general social support (Inventory of Socially Supportive Behaviors; Social Support Questionnaire), and trauma-related social support (Social Reactions Questionnaire). During 10 weeks of prolonged exposure (PE) or sertraline, depression was assessed weekly. Results: Overall, 18.0% of participants experienced a depression sudden gain, and 22.5% experienced a transient depression spike. The presence of a depression sudden gain predicted better treatment outcome, beta = -4.82, SE = 1.17, p = .001, 95% CI [-6.79, -2.90]. Higher perceptions of negative trauma-related reactions, albeit modestly, were associated with experiencing a transient depression spike (r = .18, p = .01). There were no differences in rates of depression sudden gains or transient depression spikes between treatments. Conclusions: Encouragingly, rapid improvements in depression symptoms are beneficial for PTSD treatment outcome, but transient spikes in depressive symptoms do not strongly influence outcome. Understanding symptom discontinuities may help us to personalize current PTSD treatment options.