Watchful waiting for minor depression in primary care: remission rates and predictors of improvement
Watchful waiting for minor depression in primary care: remission rates and predictors of improvement
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DOI：
10.1016/j.genhosppsych.2006.02.008
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发表时间：
2006-05-01
影响因子：
7
通讯作者：
Swick, Holly
中科院分区：
文献类型：
--
作者：
Hegel, Mark T.;Oxman, Thomas E.;Swick, Holly
目的：本研究的目的是确定在初级保健中经过1个月的观察等待期后轻度抑郁症的缓解率和改善的预测因素，并描述观察等待过程。方法：在随机进入轻度抑郁症的临床试验之前，111名参与者进入1个月的观察等待期。抑郁的严重程度和改善的预测因素在观察等待开始时进行了测量。在观察等待结束时，计算缓解率，并分析预测变量对预测改善的贡献。结果：缓解率很低，根据测量方法的不同，缓解率从9%到13%不等。回避性应对方式和在基线时参与积极愉快活动的频率是抑郁症变化的主要原因。在观察等待期间，大约五分之一的样本(21%)至少与他们的医生有过一次接触，27%的人报告使用过自我启动的治疗。结论：初级保健中有轻度抑郁症的寻求治疗的样本自发缓解的可能性很低。回避型应对方式严重干扰缓解，经常参加积极愉快的活动是一种优势。促进活动和减少回避性应对方式的初级保健可行干预措施可能会改善结果。这些发现可能不适用于社区和不寻求治疗的样本。(C)2006 Elsevier Inc.保留所有权利。
Objectives: The objectives of this study were to determine remission rates and predictors of improvement for minor depression following a 1-month watchful waiting period in primary care and to describe the watchful waiting processes.Methods: Prior to randomization into a clinical trial for minor depression, 111 participants were entered into a 1-month watchful waiting period. Depression severity and predictors of improvement were measured at the start of watchful waiting. At the end of watchful waiting, remission rates were calculated and predictor variables were analyzed for their contribution toward predicting improvement.Results: Remission rates were low, ranging from 9% to 13%, depending on the measure. Avoidant coping style and frequency of engaging in active pleasant events at baseline accounted for the majority of change in depression. During watchful waiting, about one fifth of the sample (21%) had at least one contact with their physician and 27% reported using self-initiated treatments.Conclusions: There is a low likelihood of spontaneous remission for treatment-seeking samples with minor depression in primary care. An avoidant coping style seriously interferes with remission, and engaging in regular active pleasant events confers an advantage. Feasible interventions for primary care that promote activity and decrease avoidant coping styles may improve outcomes. These findings may not generalize to community and non-treatment-seeking samples. (c) 2006 Elsevier Inc. All rights reserved.