Hair cortisol and childhood trauma predict psychological therapy response in depression and anxiety disorders
Hair cortisol and childhood trauma predict psychological therapy response in depression and anxiety disorders
复制标题
DOI：
10.1111/acps.12970
复制
发表时间：
2018-12-01
影响因子：
6.7
通讯作者：
Cleare, A. J.
中科院分区：
文献类型：
--
作者：
Fischer, S.;King, S.;Cleare, A. J.
目的：约30%-50%的抑郁症和焦虑症患者对标准心理治疗无效。考虑到皮质醇影响认知，下丘脑-垂体-肾上腺(HPA)轴功能改变的患者可能从此类治疗中受益较少。为了研究这一点，需要可靠的皮质醇前处理措施。N=抑郁症和焦虑症患者在接受改善获得心理治疗服务的治疗之前被招募。三个月后测定头发皮质醇，并进行儿童创伤问卷调查。如果患者在抑郁(患者健康问卷中为6分)或焦虑(综合焦虑量表中为5分)方面表现出显著下降，则被归类为应答者。结果与应答者相比，抑郁无应答者(57%)治疗前头发皮质醇浓度较低(P=0.041)，躯体虐待(P=0.024)、性虐待(P=0.010)和总创伤(P=0.039)更多。焦虑无反应者(48%)治疗前头发皮质醇水平较低(P=0.027)，精神虐待(P=0.034)、身体虐待(P=0.042)和总创伤(P=0.048)水平较高。如果未来的研究证实头发皮质醇是心理治疗反应的预测指标，这可能被证明是一个有用的临床生物标记物，可以识别需要更密集治疗的亚群。
Objective Method Around 30-50% of patients with depression and anxiety disorders fail to respond to standard psychological therapy. Given that cortisol affects cognition, patients with altered hypothalamic-pituitary-adrenal (HPA) axis functioning may benefit less from such treatments. To investigate this, reliable pretreatment cortisol measures are needed. N = 89 outpatients with depression and anxiety disorders were recruited before undergoing therapy within an Improving Access to Psychological Therapies (IAPT) service. Three-month hair cortisol was determined, and the Childhood Trauma Questionnaire was administered. Patients were classified as responders if they showed significant decreases in depression (>= 6 points on the Patient Health Questionnaire) or anxiety (>= 5 points on the Generalised Anxiety Disorder Scale). Results Conclusion Non-responders in terms of depression (57%) had lower pretreatment hair cortisol concentrations (P = 0.041) and reported more physical abuse (P = 0.024), sexual abuse (P = 0.010) and total trauma (P = 0.039) when compared to responders. Non-responders in terms of anxiety (48%) had lower pretreatment hair cortisol (P = 0.027), as well as higher levels of emotional abuse (P = 0.034), physical abuse (P = 0.042) and total trauma (P = 0.048). If future research confirms hair cortisol to be a predictor of psychological therapy response, this may prove a useful clinical biomarker which identifies a subgroup requiring more intensive treatment.