The Association of Baseline Suicidality With Treatment Outcome in Psychotic Depression
The Association of Baseline Suicidality With Treatment Outcome in Psychotic Depression
复制标题
DOI：
10.4088/jcp.16m10881
复制
发表时间：
2017-09-01
影响因子：
5.3
通讯作者：
Flint, Alastair J.
中科院分区：
文献类型：
--
作者：
Bingham, Kathleen S.;Rothschild, Anthony J.;Flint, Alastair J.
目的：在一项精神病性抑郁症药物治疗的随机对照试验中，研究基线自杀倾向与抑郁症结局之间的关系，并探讨自杀倾向、随机治疗分配和抑郁症结局之间的相互作用。方法：这项研究是对258名年龄在18岁或18岁以上的DSM-IV患者的数据进行的二次分析，一名参与了一项为期12周的随机对照试验（RCT）的患者，该试验比较了奥氮平加舍曲林与奥氮平加安慰剂，（精神抑郁症药物治疗研究[STOP-PD]，2002年至2007年）。独立变量为基线自杀倾向，分为4组（当前事件中的自杀企图、主动自杀意念、被动自杀意念和无自杀倾向）。结果变量为16项汉密尔顿抑郁量表（HDRS 16）总分（不包括自杀项）随时间的变化和精神病性抑郁随时间的缓解。基线自杀组与样本总体HDRS 16评分随时间的变化显著相关（F-3，F-1394 = 8.17; P <0.0001），但与随时间缓解的概率无显著相关。在分配至奥氮平组和安慰剂组的受试者中，与有被动自杀意念的受试者相比，无自杀意念的受试者的HDRS 16总分降幅更大（两组之间的变化评分差异为7.5分; 95% CI，4.3-10.7 t（1394）= 4.61，P < .0001），主动自杀意念（4.4分; 95% CI，1.4-7.4; t（1394）= 2.85，P = .0176）或自杀企图（6.1分; 95% CI，2.8-9.4; t（1394）= 3.66，P = .0015）。无自杀倾向患者的HDRS 16评分较基线的12周变化在2个治疗组之间无显著差异。然而，对于有自杀企图的患者，奥氮平+舍曲林组的12周HDRS 16改善显著大于奥氮平+安慰剂组（两组之间的变化评分差异为8.7分; 95% CI，5.1-12.4; t（1394）= 4.75，P < .0001），主动自杀意念（8.1分; 95% CI，4.5-11.7; t（1394）= 4.38，P <0.0001）或被动自杀意念（5.7分; 95% CI，2.2-9.2; t（1394）= 3.23，P = 0.0012）。结论：基线自杀倾向预测精神病性抑郁症的急性治疗结果较差。然而，有自杀倾向的受试者接受奥氮平和舍曲林联合治疗的结局优于奥氮平加安慰剂治疗的结局。
Objective: To examine the association between baseline suicidality and outcome of major depression in a randomized controlled trial of the pharmacotherapy of psychotic depression and to explore the interaction of suicidality, randomized treatment assignment, and depression outcome.Methods: This study was a secondary analysis of data from 258 persons aged 18 years or older with DSM-IV-defined major depressive disorder with psychotic features who participated in a 12-week randomized controlled trial (RCT) comparing olanzapine plus sertraline with olanzapine plus placebo (the Study of the Pharmacotherapy of Psychotic Depression [STOP-PD], which ran from 2002 to 2007). The independent variable was baseline suicidality, defined by 4 groups (suicide attempt in the current episode, active suicidal ideation, passive suicidal ideation, and no suicidality). The outcome variables were change in 16-item Hamilton Depression Rating Scale (HDRS16) total score (excluding the suicide item) over time and remission of psychotic depression over time.Results: Suicidality groups did not significantly differ on baseline HDRS16 total score. Baseline suicidality group was significantly associated with change in HDRS16 score over time in the sample as a whole (F-3,F-1394 = 8.17; P < .0001), but was not significantly associated with probability of remission over time. Among participants assigned to olanzapine and placebo, persons with no suicidality had a significantly greater reduction in HDRS16 total score compared to those with passive suicidal ideation (7.5-point difference in change scores between the 2 groups; 95% CI, 4.3-10.7 t(1394) = 4.61, P < .0001), active suicidal ideation (4.4 points; 95% CI, 1.4-7.4; t(1394) = 2.85, P = .0176), or suicide attempts (6.1 points; 95% CI, 2.8-9.4; t(1394) = 3.66, P = .0015). The 12-week change from baseline in HDRS16 score for patients with no suicidality was not significantly different between the 2 treatment arms. However, the 12-week HDRS16 improvement was significantly greater in the olanzapine plus sertraline arm, compared with the olanzapine plus placebo arm, for patients with suicide attempts (8.7-point difference in change scores between the 2 groups; 95% CI, 5.1-12.4; t(1394) = 4.75, P < .0001), active suicidal ideation (8.1 points; 95% CI, 4.5-11.7; t(1394) = 4.38, P < .0001), or passive suicidal ideation (5.7 points; 95% CI, 2.2-9.2; t(1394) = 3.23, P = .0012), respectively.Conclusions: Baseline suicidality predicted worse acute treatment outcome of psychotic depression. However, participants with suicidality had a better outcome when treated with the combination of olanzapine and sertraline than when treated with olanzapine plus placebo.