WHICH SYMPTOMS PREDICT RECURRENCE OF DEPRESSION IN WOMEN TREATED WITH MAINTENANCE INTERPERSONAL PSYCHOTHERAPY?
WHICH SYMPTOMS PREDICT RECURRENCE OF DEPRESSION IN WOMEN TREATED WITH MAINTENANCE INTERPERSONAL PSYCHOTHERAPY?
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DOI：
10.1002/da.20467
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发表时间：
2008-01-01
影响因子：
7.4
通讯作者：
Frank, Ellen
中科院分区：
文献类型：
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作者：
Dombrovski, Alexandre Y.;Cyranowski, Jill M.;Frank, Ellen
背景：即使是低水平的残留症状也会增加重性抑郁症复发和早期复发的风险。目前尚不清楚持续的心理治疗是否会降低这种风险。因此，我们研究了持续症状（包括情绪、失眠和焦虑症状）对接受维持性人际心理治疗（IPT-M）治疗复发性抑郁症的女性复发时间的影响。方法：我们分析了131名20-60岁女性的数据，这些数据来自一项为期2年的随机试验，分别是每周、每月两次和每月一次IPT-M。参与者通过单独IPT （n = 99）或IPT加序贯抗抑郁药物治疗（n = 32）获得缓解。在开始维持治疗前，药物逐渐减少。剩余症状采用汉密尔顿抑郁评定量表（HRSD，总分和亚量表）评定；对76名女性的失眠症进行了匹兹堡睡眠质量指数（PSQI）评估。数据分析采用Cox比例风险回归模型。结果：残留症状总负担（HRSD总分）和HRSD情绪和焦虑亚量表评分均不能预测持续IPT-M期间的复发。相比之下，HRSD-17失眠亚量表和PSQI测量的持续性失眠症预测复发。需要序贯药物治疗的持续性失眠症女性复发率最高（65%），而不需要序贯治疗的女性复发率最高（13%），或仅通过IPT恢复但有持续性失眠症（21%）或无失眠症的女性复发率最高。(18%)。结论：复发性重度抑郁症发作后恢复的持续性失眠与复发风险增加相关，尽管维持心理治疗，特别是对那些停止抗抑郁药物治疗的患者。抑郁与焦虑，2008。(C) 2008 Wiley-Liss, Inc。
Background: Even low levels of residual symptoms are known to increase the risk of relapse and early recurrence of major depression. It is not known if ongoing psychotherapy lessens this risk. We therefore examined the impact of persistent symptoms, including mood, insomnia, and anxiety symptoms, on time to recurrence in women receiving maintenance interpersonal psychotherapy (IPT-M) for recurrent depression. Methods: We analyzed data on 131 women aged 20-60 from a 2-year randomized trial of weekly versus twice-monthly versus monthly IPT-M. Participants achieved remission with IPT alone (n = 99) or IPT plus sequential antidepressant medication (n = 32). Medications were tapered before starting maintenance treatment. Residual symptoms were assessed with the Hamilton Rating Scale for Depression (HRSD; total score and subscales); insomnia was also assessed in 76 women with the Pittsburgh Sleep Quality Index (PSQI). Data analyses used Cox proportional hazards regression models. Results: Neither overall burden of residual symptoms (HRSD total score), nor HRSD mood and anxiety subscale scores predicted recurrence during ongoing IPT-M. In contrast, persistent insomnia measured both by the HRSD-17 insomnia subscale and the PSQI predicted recurrence. Women with persistent insomnia who required sequential pharamacotherapy had the highest recurrence rate (65%) compared to women requiring sequential treatment without insomnia (13%), or women who had recovered with IPT alone but had persistent insomnia (21%) or no insomnia. (18%). Conclusions: Persistent insomnia following the recovery from an episode of recurrent major depression is associated with increased risk of recurrence despite maintenance psychotherapy, particularly for those withdrawn from antidepressant medication. Depression and Anxiety 25:1060-1066, 2008. (C) 2008 Wiley-Liss, Inc.