Predictors of treatment response for depression and inadequate social support - The ENRICHD Randomized clinical trial
Predictors of treatment response for depression and inadequate social support - The ENRICHD Randomized clinical trial
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DOI：
10.1159/000110057
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发表时间：
2008-01-01
影响因子：
22.8
通讯作者：
Czajkowski, Susan M.
中科院分区：
文献类型：
--
作者：
Cowan, Marie J.;Freedland, Kenneth E.;Czajkowski, Susan M.
目的：确定治疗暴露的“剂量”、认知行为疗法（CBT）特定成分的提供、患者依从性和/或抗抑郁药的使用是否可预测认知行为治疗6个月后良好的抑郁和社会支持结果。对急性心肌梗死患者参与的增强冠心病恢复（ENRICHD）临床试验干预组的次要分析（MI）：抑郁结果n = 641，社会支持结果n = 523。结果测量抑郁：贝克抑郁量表（BDI）和汉密尔顿抑郁量表（HAM-D）;社会支持：ENRICHD社会支持量表（ESSI）和领悟社会支持量表（PSSS）。更好的抑郁结局（由BDI测量）接受了大量的抑郁症特异性干预成分，p < 0.01，完成作业比例高，p < 0.02。更好的抑郁结果（由HAM-D测量）是接受了大量的社会沟通和干预的自信成分，p < 0.01，并完成了高比例的家庭作业，p < 0.01。更好的社会支持结果（由ESSI和PSSS测量）分别由种族或少数民族群体成员预测，p < 0.02和p < 0.01;完成更多的家庭作业，p < 0.01和p < 0.05。交付的社会沟通和自信的干预组件是一个更糟糕的社会支持结果的独立预测因子，p < 0.01（测量的PSSS）。结论：抑郁症的CBT的标准组件是有用的，在治疗共病抑郁症后MI患者。致力于沟通技巧可能有助于改善抑郁症，但不一定有助于改善这一患者人群的社会支持结果，而坚持认知行为作业对这两种结果都很重要。旨在改善社会支持的ENRICHD干预措施的其他组成部分对结果没有明显影响。为了在未来的心肌梗死后临床试验中获得更好的结果，可能需要改进干预措施。更加重视CBT家庭作业的坚持可以改善抑郁症和社会支持的结果。版权所有（c）2008 S. Karger AG，巴塞尔。
Objective: To determine whether the 'dose' of treatment exposure, delivery of specific components of cognitive behavior therapy (CBT), patient adherence and/or use of antidepressants predict favorable depression and social support outcomes after 6 months of cognitive behavioral treatment.Methods: Secondary analyses of the intervention arm of the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial involving persons with acute myocardial infarction (MI): n = 641 for the depression outcomes and n = 523 for the social support outcomes. The outcome measures were, for depression: the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D); for social support: the ENRICHD Social Support Instrument (ESSI) and Perceived Social Support Scale (PSSS).Results: Better depression outcomes (measured by the BDI) were receiving a high number of depression- specific intervention components, p < 0.01, and completing a high proportion of homework assignments, p < 0.02. Better depression outcomes (measured by the HAM-D) were receiving a high number of the social communication and assertiveness components of the intervention, p < 0.01, and completing a high proportion of homework assignments, p < 0.01. Better social support outcomes (measured by the ESSI and PSSS) were predicted by membership in a racial or ethnic minority group, p < 0.02 and p < 0.01, respectively; and by completing a higher number of homework assignments, p < 0.01 and p < 0.05, respectively. Delivery of the social communication and assertiveness components of the intervention was an independent predictor of a worse social support outcome, p < 0.01 ( measured by the PSSS).Conclusions: The standard components of CBT for depression are useful in treating comorbid depression in post-MI patients. Working on communication skills may help to improve depression but not necessarily social support outcomes in this patient population, while adherence to cognitive- behavioral homework assignments is important for both outcomes. Other components of the ENRICHD intervention that were designed to improve social support had no discernible effects on outcomes. Intervention refinements may be needed in order to achieve better results in future post- MI clinical trials. A greater emphasis on CBT homework adherence could improve both depression and social support outcomes. Copyright (c) 2008 S. Karger AG, Basel.