Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial.
Early Improvement in Work Productivity Predicts Future Clinical Course in Depressed Outpatients: Findings From the CO-MED Trial.
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DOI：
10.1176/appi.ajp.2016.16020176
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发表时间：
2016-12-01
期刊：
影响因子：
--
通讯作者：
Trivedi MH
中科院分区：
文献类型：
--
作者：
Jha MK;Minhajuddin A;Greer TL;Carmody T;Rush AJ;Trivedi MH
抑郁症症状严重程度是抗抑郁药物治疗试验中最常见的研究结果，在与严重抑郁症有关的负担中只占一小部分。虽然丧失工作效率是造成抑郁症经济负担的最大因素，但很少有研究系统地评估治疗对工作效率的独立影响，以及工作效率的变化与较长期临床病程之间的关系。通过工作生产率和活动损伤(WPAI)自我报告，对331名参加联合药物提高抑郁结果(CO-MED)试验的患有严重抑郁症的受试者重复测量工作效率。确定了治疗前6周内工作效率变化的轨迹，并用于预测3个月和7个月后的缓解。参与者报告说，即使在控制了抑郁严重程度的变化后，使用抗抑郁药物治疗也减少了缺勤，提高了工作效率。工作效率的变化有三个不同的轨迹：1)强劲的早期改善(24%)，2)微小的变化(49%)，以及3)高损伤轻微减少(27%)。与其他参与者相比，即使在第6周控制了选定的基线变量和缓解状态后，那些有显著改善的患者在3个月时的缓解率是其他参与者的3-5倍，在7个月时的缓解率是2-5倍。在这项二次分析中，自我报告的工作效率在接受抗抑郁药物治疗的抑郁症患者中有所改善，即使考虑到抑郁症状的减少。早期工作效率的提高与治疗3个月和7个月后更高的缓解率有关。
Depression symptom severity, the most commonly studied outcome in antidepressant treatment trials, accounts for only a small portion of burden related to major depression. While lost work productivity is the biggest contributor to depression’s economic burden, few studies have systematically evaluated the independent effect of treatment on work productivity and the relationship between changes in work productivity and longer-term clinical course. Work productivity was measured repeatedly by the Work Productivity and Activity Impairment (WPAI) self-report in 331 employed participants with major depression enrolled in the Combining Medications to Enhance Depression Outcomes (CO-MED) trial. Trajectories of change in work productivity during the first 6 weeks of treatment were identified and used to predict remission at 3 and 7 months. Participants reported reduced absence from work and increased work productivity with antidepressant treatment even after controlling for changes in depression severity. Three distinct trajectories of changes in work productivity were identified: 1) robust early improvement (24%), 2) minimal change (49%), and 3) high-impairment slight reduction (27%). As compared to other participants, those with robust improvement had 3–5 times higher remission rates at 3 months and 2–5 times higher remission rates at 7 months, even after controlling for select baseline variables and remission status at week 6. In this secondary analysis, self-reported work productivity improved in depressed patients with antidepressant treatment even after accounting for depressive symptom reduction. Early improvement in work productivity is associated with much higher remission rates after 3 and 7 months of treatment.
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