Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review.
Empirical evidence for definitions of episode, remission, recovery, relapse and recurrence in depression: a systematic review.
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DOI：
10.1017/s2045796018000227
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发表时间：
2019-10
影响因子：
8.1
通讯作者：
de Jonge P
中科院分区：
文献类型：
--
作者：
de Zwart PL;Jeronimus BF;de Jonge P
在过去的四分之一个世纪里，弗兰克等人s（1991）对重性抑郁症（MDD）发作、缓解、恢复、复发和复发的共识性定义是MDD研究和临床实践一致性的最重要驱动力。本研究的目的是回顾弗兰克等人的经验验证的证据。提出的概念定义，并讨论基于证据的修改。1991年1月1日至2017年8月30日期间对Web of Science和PubMed进行的文献检索识别出了引用Frank等人的所有出版物。的定义验证请求。纳入了具有验证相关数据的出版物，并检查其是否参考了提供此类数据的其他研究。共纳入56项研究，涉及39 315例受试者，主要提供数据以验证定义缓解和恢复的严重程度和持续时间阈值。大多数研究表明，定义缓解的严重程度阈值应降低。此外，将缓解与恢复分开的特定持续时间阈值并没有增加任何预测价值，即缓解持续时间增加会增加抑郁症状复发的风险。只有有限的数据可用于验证定义抑郁发作的严重程度和持续时间标准。缓解最好定义为比先前假设的症状更少的状态（汉密尔顿抑郁评定量表，17项版本（HAMD-17）104而不是107），而不应用持续时间标准。将缓解与恢复分开的持续时间阈值没有意义。定义抑郁发作的抑郁症状的最短持续时间应超过2周，尽管需要进一步的研究来推荐确切的持续时间阈值。这些结果与旨在使用循证抑郁症结果的研究人员和临床医生相关。
For the past quarter of a century, Frank et al.’s (1991) consensus-based definitions of major depressive disorder (MDD) episode, remission, recovery, relapse and recurrence have been the paramount driving forces for consistency in MDD research as well as in clinical practice. This study aims to review the evidence for the empirical validation of Frank et al.’s proposed concept definitions and to discuss evidence-based modifications. A literature search of Web of Science and PubMed from 1/1/1991 to 08/30/2017 identified all publications which referenced Frank et al.’s request for definition validation. Publications with data relevant for validation were included and checked for referencing other studies providing such data. A total of 56 studies involving 39 315 subjects were included, mainly presenting data to validate the severity and duration thresholds for defining remission and recovery. Most studies indicated that the severity threshold for defining remission should decrease. Additionally, specific duration thresholds to separate remission from recovery did not add any predictive value to the notion that increased remission duration alleviates the risk of reoccurrence of depressive symptoms. Only limited data were available to validate the severity and duration criteria for defining a depressive episode. Remission can best be defined as a less symptomatic state than previously assumed (Hamilton Rating Scale for Depression, 17-item version (HAMD-17) ⩽4 instead of ⩽7), without applying a duration criterion. Duration thresholds to separate remission from recovery are not meaningful. The minimal duration of depressive symptoms to define a depressive episode should be longer than 2 weeks, although further studies are required to recommend an exact duration threshold. These results are relevant for researchers and clinicians aiming to use evidence-based depression outcomes.