Predictors and moderators of acute outcome in the Treatment for Adolescents with Depression Study (TADS)
Predictors and moderators of acute outcome in the Treatment for Adolescents with Depression Study (TADS)
复制标题
DOI：
10.1097/01.chi.0000240838.78984.e2
复制
发表时间：
2006-12-01
影响因子：
13.3
通讯作者：
March, John
中科院分区：
文献类型：
--
作者：
Curry, John;Rohde, Paul;March, John
目的：在青少年抑郁症治疗研究（TADS）中，确定随机分配到氟西汀、认知行为治疗（CBT）、氟西汀和CBT联合治疗或口服安慰剂临床治疗的抑郁青少年（N = 439）对急性治疗反应的预测因素和调节因素。方法：通过文献回顾确定潜在的基线预测因子和调节因子。结果测量是根据儿童抑郁评定量表修订（CDRS-R）得出的第12周预测分数。对于每个候选调节因子或预测因子，采用一般线性模型来检查治疗和候选变量对CDRS-R预测分数的主要和交互影响。结果：较年轻、较少慢性抑郁、较高功能、较少绝望、较少自杀意念、较少忧郁特征或合并症诊断、以及对改善有较大期望的青少年比他们的同行更有可能获益。在不低于单一疗法的情况下，联合治疗对轻度至中度抑郁症和重度认知扭曲抑郁症比氟西汀更有效，但对重度抑郁症或轻度认知扭曲抑郁症则没有效果。来自高收入家庭的青少年从单独的CBT和联合治疗中获益的可能性是一样的。结论：较年轻和较轻损伤的青少年对急性治疗的反应可能比较年长、较损伤或多重合并症的青少年更好。家庭收入水平、认知扭曲和抑郁症的严重程度可能有助于临床医生选择急性干预措施，但在调节因子存在的情况下，联合治疗被证明是有效的。
Objective: To identify predictors and moderators of response to acute treatments among depressed adolescents (N = 439) randomly assigned to fluoxetine, cognitive-behavioral therapy (CBT), both fluoxetine and CBT, or clinical management with pill placebo in the Treatment for Adolescents With Depression Study (TADS). Method: Potential baseline predictors and moderators were identified by a literature review. The outcome measure was a week 12 predicted score derived from the Children's Depression Rating Scale-Revised (CDRS-R). For each candidate moderator or predictor, a general linear model was conducted to examine main and interactive effects of treatment and the candidate variable on the CDRS-R predicted scores. Results: Adolescents who were younger, less chronically depressed, higher functioning, and less hopeless with less suicidal ideation, fewer melancholic features or comorbid diagnoses, and greater expectations for improvement were more likely to benefit acutely than their counterparts. Combined treatment, under no condition less effective than monotherapy, was more effective than fluoxetine for mild to moderate depression and for depression with high levels of cognitive distortion, but not for severe depression or depression with low levels of cognitive distortion. Adolescents from high-income families were as likely to benefit from CBT alone as from combined treatment. Conclusions: Younger and less severely impaired adolescents are likely to respond better to acute treatment than older, more impaired, or multiply comorbid adolescents. Family income level, cognitive distortions, and severity of depression may help clinicians to choose among acute interventions, but combined treatment proved robust in the presence of moderators.