IMPACT OF CHILDHOOD TRAUMA ON THE OUTCOMES OF A PERINATAL DEPRESSION TRIAL
IMPACT OF CHILDHOOD TRAUMA ON THE OUTCOMES OF A PERINATAL DEPRESSION TRIAL
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DOI：
10.1002/da.21929
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发表时间：
2012-07-01
影响因子：
7.4
通讯作者：
Katon, Wayne
中科院分区：
文献类型：
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作者：
Grote, Nancy K.;Spieker, Susan J.;Katon, Wayne
背景 童年时期的虐待和忽视与成年后不良心理健康结果的风险增加有关，并且可能会调节或预测对抑郁症治疗的反应。在一项针对不寻求治疗的孕妇、低收入女性的不同样本中治疗抑郁症的小型随机对照试验中，我们假设，对于分配到常规护理（UC）的女性来说，童年创伤暴露会随着时间的推移缓和症状和功能的变化，但不会减轻短期人际心理治疗（IPT-B）和维持性 IPT 治疗的女性的症状和功能随时间的变化。其次，我们预测，对于 UC 内的女性来说，随着时间的推移以及在两个随访时间点，创伤暴露将与治疗反应呈负相关，但对于 IPT-B 内的女性则不然，无论创伤暴露如何，预计她们的抑郁严重程度和其他结果都会得到缓解。方法 53 名低收入孕妇被随机分配至 IPT-B（n = 25）或 UC（n = 28）组。纳入标准包括 18 岁、爱丁堡产后抑郁量表 >12、妊娠 1032 周、会说英语、可以使用电话。对参与者的童年创伤、抑郁症状/诊断、焦虑症状、社会功能和人际关系问题进行评估。结果回归和混合效应重复测量分析显示，与 IPT-B 患者相比，创伤暴露并不能缓和 UC 女性症状和功能随时间的变化。协方差分析显示，在 IPT-B 组中，遭受创伤较多的女性与较少遭受创伤的女性在基线后 3 个月的抑郁严重程度较高，预后较差。产后 6 个月时，她们的抑郁症状和功能有所缓解，但与创伤较少的女性相比，她们的残余抑郁症状也更多。结论 童年创伤并不能预测 IPT-B 组产后 6 个月的不良结局，而在基线后 3 个月则如此，这表明包括维持治疗在内的 IPT 是治疗该人群抑郁症的合理方法。由于遭受更多创伤的女性在产后 6 个月时残留的抑郁症状较多，因此她们可能需要更长的维持治疗以防止抑郁复发。
Background Childhood abuse and neglect have been linked with increased risks of adverse mental health outcomes in adulthood and may moderate or predict response to depression treatment. In a small randomized controlled trial treating depression in a diverse sample of nontreatment-seeking, pregnant, low-income women, we hypothesized that childhood trauma exposure would moderate changes in symptoms and functioning over time for women assigned to usual care (UC), but not to brief interpersonal psychotherapy (IPT-B) followed by maintenance IPT. Second, we predicted that trauma exposure would be negatively associated with treatment response over time and at the two follow-up time points for women within UC, but not for those within IPT-B who were expected to show remission in depression severity and other outcomes, regardless of trauma exposure. Methods Fifty-three pregnant low-income women were randomly assigned to IPT-B (n = 25) or UC (n = 28). Inclusion criteria included =18 years, >12 on the Edinburgh Postnatal Depression Scale, 1032 weeks gestation, English speaking, and access to a phone. Participants were evaluated for childhood trauma, depressive symptoms/diagnoses, anxiety symptoms, social functioning, and interpersonal problems. Results Regression and mixed effects repeated measures analyses revealed that trauma exposure did not moderate changes in symptoms and functioning over time for women in UC versus IPT-B. Analyses of covariance showed that within the IPT-B group, women with more versus less trauma exposure had greater depression severity and poorer outcomes at 3-month postbaseline. At 6-month postpartum, they had outcomes indicating remission in depression and functioning, but also had more residual depressive symptoms than those with less trauma exposure. Conclusions Childhood trauma did not predict poorer outcomes in the IPT-B group at 6-month postpartum, as it did at 3-month postbaseline, suggesting that IPT including maintenance sessions is a reasonable approach to treating depression in this population. Since women with more trauma exposure had more residual depressive symptoms at 6-month postpartum, they might require longer maintenance treatment to prevent depressive relapse.