Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder
Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder
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DOI：
10.1001/archpsyc.57.1.29
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发表时间：
2000-01-01
影响因子：
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通讯作者：
Ulloa, RE
中科院分区：
文献类型：
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作者：
Birmaher, B;Brent, DA;Ulloa, RE
背景：认知行为疗法在青少年重度抑郁障碍的急性治疗中被证明比其他心理社会干预更有效。然而，短期心理社会干预对青少年抑郁症病程的长期影响还没有得到很好的证实。方法：107例重度抑郁障碍的青少年随机分为认知行为疗法、系统行为家庭疗法或非定向支持疗法，在心理治疗试验结束后进行为期2年的评估，以记录随后的病程和预测因素。结果：3种心理疗法的长期疗效没有差异。大多数参与者(80%)恢复(中位时间，距基线8.2个月)，30%复发(中位时间，距恢复4.2个月)。21%的人在至少80%的随访期内患有抑郁症。抑郁的严重程度(基线时)和自我报告的亲子冲突的存在(基线时和随访期间)预示着缺乏康复、慢性化和复发。尽管与基线时临床转诊的患者相似，但通过广告招募的患者复发的可能性较小。结论：认知行为治疗、系统行为家庭治疗和非指导性支持治疗在长期结果方面没有显著差异。虽然这项研究中的大多数参与者最终都康复了，但那些患有严重抑郁症和自我感觉到的亲子冲突的人患慢性抑郁症和复发的风险更大。
Background: Cognitive behavioral therapy has been shown to be more efficacious than alternative psychosocial interventions for the acute treatment of adolescents with major depressive disorder. However, the long-term impact of brief psychosocial interventions on the course of adolescent depression is not well established.Methods: One hundred seven adolescents with major depressive disorder randomly assigned to 12 to 16 weeks of cognitive behavioral therapy, systemic behavioral family therapy, or nondirective supportive therapy were evaluated for 2 years after the psychotherapy trial to document the subsequent course and predictors of major depressive disorder.Results: There were no long-term differential effects of the 3 psychotherapies. Most participants (80%) recovered (median time, 8.2 months from baseline), and 30% had a recurrence (median time, 4.2 months from recovery). Twenty-one percent were depressed during at least 80% of the follow-up period. Severity of depression (at baseline) and presence of self-reported parent-child conflict (at baseline and during the follow-up period) predicted lack of recovery, chronicity, and recurrence. Despite the similarity to clinically referred patients at baseline, patients recruited via advertisement were less likely to experience a recurrence.Conclusions: There were no significant differences in long-term outcome among cognitive behavioral therapy, systematic behavioral family therapy, and nondirective supportive therapy. While most participants in this study eventually recovered, those with severe depression and self-perceived parent-child conflict are at greater risk for chronic depression and recurrences.