Impact of PTSD comorbidity on one-year outcomes in a depression trial
Impact of PTSD comorbidity on one-year outcomes in a depression trial
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DOI：
10.1002/jclp.20279
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发表时间：
2006-07-01
影响因子：
3
通讯作者：
Chung, Joyce
中科院分区：
文献类型：
--
作者：
Green, Bonnie L.;Krupnick, Janice L.;Chung, Joyce
低收入非裔美国人、拉丁裔和白人妇女被筛选并招募到社会服务和计划生育机构进行抑郁症治疗试验。那些符合重度抑郁症全部标准的患者（MDD：N = 267）被随机分配接受认知行为治疗（CBT）、抗抑郁药物或社区心理健康转诊。所有随机分配的参与者均通过基线电话和临床访谈进行评估，并进行为期一年的电话随访。在基线和一年随访的临床访谈中评估创伤后应激障碍（PTSD）合并症。在基线时，33% 的抑郁女性目前患有 PTSD。这些参与者比单独患有抑郁症的女性更容易遭受攻击性暴力，抑郁和焦虑程度更高，而且功能受损更严重。两组的抑郁症在一年内都有所改善，但创伤后应激障碍 (PTSD) 亚组在一年的随访期间仍然受到更严重的损害。因此，无论是否有 PTSD 合并症，循证治疗（抗抑郁药物或结构化心理治疗）都能减少抑郁症，但患有 PTSD 的女性自始至终都更加痛苦和受损。对与人际暴力相关的创伤后应激障碍进行直接治疗可能更有效地缓解患有这两种诊断的患者的抑郁症。 (c) 2006 年 Wiley 期刊公司
Low-income African American, Latino, and White women were screened and recruited for a depression treatment trial in social service and family planning settings. Those meeting full criteria for major depression (MDD: N = 267) were randomized to cognitive-behavior therapy (CBT), antidepressant medication, or community mental health referral. All randomly assigned participants were evaluated by baseline telephone and clinical interview, and followed by telephone for one year. Posttraumatic stress disorder (PTSD) comorbidity was assessed at baseline and one-year follow-up in a clinical interview. At baseline, 33% of the depressed women had current comorbid PTSD. These participants had more exposure to assaultive violence, had higher levels of depression and anxiety, and were more functionally impaired than women with depression alone. Depression in both groups improved over the course of one year, but the PTSD subgroup remained more impaired throughout the one-year follow-up period. Thus, evidence-based treatments (antidepressant medication or structured psychotherapy) decrease depression regardless of PTSD comorbidity, but women with PTSD were more distressed and impaired throughout. Including direct treatment of PTSD associated with interpersonal violence may be more effective in alleviating depression in those with both diagnoses. (c) 2006 Wiley Periodicals, Inc.