Cognitive and affective trait and state factors influencing the long-term symptom course in remitted depressed patients
Cognitive and affective trait and state factors influencing the long-term symptom course in remitted depressed patients
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DOI：
10.1371/journal.pone.0178759
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发表时间：
2017-06-02
期刊：
影响因子：
3.7
通讯作者：
Kuehner, Christine
中科院分区：
文献类型：
--
作者：
Timm, Christina;Ubl, Bettina;Kuehner, Christine
背景重度抑郁症（MDD）的特点是复发和慢性发展的高风险。残余症状等临床特征已被证明会对 MDD 的长期病程产生负面影响。然而，迄今为止，尚不清楚特质重复消极思维（RNT）以及认知和情感瞬时状态（后者在日常生活中经历）如何影响 MDD 的长期病程。方法我们在基线后 6（T2）和 36（T3）个月对 57 名缓解抑郁（rMDD）个体进行了随访。临床结果包括复发时间、作为慢性标志的显着症状所花费的时间以及 T2 和 T3 时的抑郁症状水平。基线评估的预测因素包括残留症状和特征 RNT。此外，使用动态评估（AA）在基线评估瞬时日常生活影响和瞬时沉思及其在一天中的变化。结果在多个模型中，基线时的残余症状和日常生活影响的不稳定独立预测更快的复发时间，而特征RNT显着预测慢性性。多水平模型显示，随访期间的抑郁症状水平是通过基线残留症状水平和日常生活沉思的不稳定性来预测的。这两种不稳定特征都与更多的记忆性 MDD 发作有关。结论我们的研究结果表明，RNT 特质以及日常生活中的情感和认知过程都会影响 MDD 的长期病程。未来有必要对各个 AA 表型作为潜在的跨诊断过程修饰因素的作用进行纵向研究。
BackgroundMajor depressive disorder (MDD) is characterized by a high risk for relapses and chronic developments. Clinical characteristics such as residual symptoms have been shown to negatively affect the long-term course of MDD. However, it is unclear so far how trait repetitive negative thinking (RNT) as well as cognitive and affective momentary states, the latter experienced during daily-life, affect the long-term course of MDD.MethodWe followed up 57 remitted depressed (rMDD) individuals six (T2) and 36 (T3) months after baseline. Clinical outcomes were time to relapse, time spent with significant symptoms as a marker of chronicity, and levels of depressive symptoms at T2 and T3. Predictors assessed at baseline included residual symptoms and trait RNT. Furthermore, momentary daily life affect and momentary rumination, and their variation over the day were assessed at baseline using ambulatory assessment (AA).ResultsIn multiple models, residual symptoms and instability of daily-life affect at baseline independently predicted a faster time to relapse, while chronicity was significantly predicted by trait RNT. Multilevel models revealed that depressive symptom levels during follow-up were predicted by baseline residual symptom levels and by instability of daily-life rumination. Both instability features were linked to a higher number of anamnestic MDD episodes.ConclusionsOur findings indicate that trait RNT, but also affective and cognitive processes during daily life impact the longer-term course of MDD. Future longitudinal research on the role of respective AA-phenotypes as potential transdiagnostic course-modifiers is warranted.