Incorporating Multidimensional Patient-Reported Outcomes of Symptom Severity, Functioning, and Quality of Life in the Individual Burden of Illness Index for Depression to Measure Treatment Impact and Recovery in MDD
Incorporating Multidimensional Patient-Reported Outcomes of Symptom Severity, Functioning, and Quality of Life in the Individual Burden of Illness Index for Depression to Measure Treatment Impact and Recovery in MDD
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DOI：
10.1001/jamapsychiatry.2013.286
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发表时间：
2013-03-01
期刊：
影响因子：
25.8
通讯作者：
Ishak, Waguih William
中科院分区：
文献类型：
--
作者：
Cohen, Robert M.;Greenberg, Jared M.;Ishak, Waguih William
内容：国家精神卫生研究所情感障碍工作组认为，评估个人的疾病负担是一项重要的需求。抑郁症的个体疾病负担指数（IBI-D）度量是为了满足这一需求而开发的。目的：评估IBI-D在抑郁症患者治疗效果的多维评估中的应用。设计、设置和患者：关于抑郁症状严重程度、功能、抑郁症患者（N=2280）在进入和退出缓解抑郁症序贯治疗替代方案（星星 *D）研究1级时的生活质量（QOL）（12周西酞普兰治疗）被用来作为计算IBI-D和自评量表changes.Results的基础：主成分分析的患者反应在年底的星星 *D的1级产生了一个单一的主成分，IBI-D，与以前报道的几乎相同的特征向量。虽然症状严重程度的变化（抑郁症状快速量表-自我报告）仅解释了生活质量变化的50%方差（生活质量享受和满意度量表-简表）和47%的功能变化方差（工作和社会适应量表），IBI-D的变化捕获了QOL变化的83%和功能变化的80%，同时还捕获了症状严重程度变化的79%的方差（抑郁症状快速清单-自我报告）。最重要的是，36.6%的QOL和/或功能异常的缓解者IBI-D的变化（平均值[SD]，2.98 [0.35]）显著小于报告QOL和功能正常的缓解者IBI-D的变化（IBI-D=1.97; t=32.6; P < 10（-8）），效应量Cohen d为2.58。相比之下，症状严重程度的差异，虽然显着，科恩d只有0.78。结论：抑郁症患者的缓解，定义为症状严重程度的降低，并不意味着正常的生活质量或功能。通过纳入多维患者报告的结果，IBI-D提供了一个单一的衡量标准，充分反映了治疗前后抑郁症的全部疾病负担;因此，它提供了一个更准确的恢复指标。试验注册：clinicaltrials.gov标识符：NCT 00021528 JAMA Psychiatry。2013;70（3）：343-350. 2013年1月2日在线发布。doi：10.1001/jamapsychiatry.2013.286
Context: The National Institute of Mental Health Affective Disorders Workgroup identified the assessment of an individual's burden of illness as an important need. The Individual Burden of Illness Index for Depression (IBI-D) metric was developed to meet this need.Objective: To assess the use of the IBI-D for multidimensional assessment of treatment efficacy for depressed patients.Design, Setting, and Patients: Complete data on depressive symptom severity, functioning, and quality of life (QOL) from depressed patients (N=2280) at entry and exit of level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (12-week citalopram treatment) were used as the basis for calculating IBI-D and self-rating scale changes.Results: Principal component analysis of patient responses at the end of level 1 of STAR*D yielded a single principal component, IBI-D, with a nearly identical eigen-vector to that previously reported. While changes in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report) accounted for only 50% of the variance in changes in QOL (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) and 47% of the variance in changes in functioning (Work and Social Adjustment Scale), changes in IBI-D captured 83% of the variance in changes in QOL and 80% in functioning, while also capturing 79% of the variance in change in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report). Most importantly, the changes in IBI-D of the 36.6% of remitters who had abnormal QOL and/or functioning (mean [SD], 2.98 [0.35]) were significantly less than the changes in IBI-D of those who reported normal QOL and functioning (IBI-D=1.97; t=32.6; P < 10(-8)) with an effect size of a Cohen d of 2.58. In contrast, differences in symptom severity, while significant, had a Cohen d of only 0.78.Conclusions: Remission in depressed patients, as defined by a reduction in symptom severity, does not denote normal QOL or functioning. By incorporating multidimensional patient-reported outcomes, the IBI-D provides a single measure that adequately captures the full burden of illness in depression both prior to and following treatment; therefore, it offers a more accurate metric of recovery. Trial Registration: clinicaltrials.gov Identifier: NCT00021528 JAMA Psychiatry. 2013;70(3):343-350. Published online January 2, 2013. doi:10.1001/jamapsychiatry.2013.286