A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder.
A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder.
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DOI：
10.1016/j.jad.2015.08.026
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发表时间：
2015-11-15
影响因子：
6.6
通讯作者：
Sanacora G
中科院分区：
文献类型：
--
作者：
Niciu MJ;Abdallah CG;Fenton LR;Fasula MK;Black A;Anderson GM;Sanacora G
临床上需要以循证为基础的心理治疗反应生物标记物来治疗重度抑郁障碍。基于以前的研究，我们假设，较低的24小时尿皮质醇水平和早期生活压力/创伤史将预测认知行为疗法(CBT)的抗抑郁药物反应改善。入选了50名目前患有抑郁症的MDD受试者。收集24小时尿液，用放射免疫法测定皮质醇水平。受试者还接受了基线的早期生活压力/创伤测量：全球感知早期生活压力(GPELS)、早期生活创伤问卷(ELTI)和克莱恩损失量表(KLS)。在基线和每4周进行一次为期12周的CBT治疗，并在基线和之后每周进行一次Beck抑郁量表的评定，以评估其疗效。42名受试者进行了至少一次完整的随访(≥为期4周)，30名受试者完成了为期12周的完整疗程。基线24小时尿皮质醇水平与CBT的抗抑郁反应无关。较高的KLS评分(衡量早期父母丧失或分离的指标)与德尔塔高密度脂蛋白2 4相关(rS=−0.39，经P调整=0.0 5)。互补性一般线性模型分析显示，有早年父母丧失或分居病史的患者CBT疗效增强[F(1，35)=6.65，p=0.01]。样本量小，待遇幼稚的人群。在我们的样本中，早年父母的分离或丧失与CBT的抗抑郁疗效呈正相关，可能值得在更大的临床样本中进行进一步研究。
There is a clinical need for evidence-based psychotherapy response biomarkers in major depressive disorder (MDD). Based on previous studies, we hypothesized that lower 24-h urinary cortisol levels and a history of early life stress/trauma would predict an improved antidepressant response to cognitive-behavioral therapy (CBT). 50 currently depressed MDD subjects were enrolled. 24-h urine was collected and measured for cortisol levels by radioimmunoassay (RIA). Subjects were also administered early life stress/trauma measures at baseline: Global Perceived Early-Life Stress (GPELS), The Early Life Trauma Inventory (ELTI) and Klein Loss Scale (KLS). The efficacy of a twelve-week course of once-weekly CBT was evaluated by the primary outcome measure, the 24-item Hamilton Depression Rating Scale (HDRS24), at baseline and every four weeks, and the Beck Depression Inventory at baseline and weekly thereafter. 42 subjects had at least one complete follow-up visit (≥4 weeks of CBT), and 30 subjects completed the full 12-week course. Baseline 24-h urinary cortisol levels did not correlate with CBT’s antidepressant response. Higher KLS scores, a measure of early life parental loss or separation, correlated with delta HDRS24 (rs=−0.39, padjusted=0.05). Complementary general linear model analysis revealed enhanced CBT efficacy in patients with a history of early life parental loss or separation [F(1,35)=6.65, p=0.01]. Small sample size, Treatment-naïve population. Early life parental separation or loss positively correlated with CBT’s antidepressant efficacy in our sample and may warrant further study in larger clinical samples.