How much change is enough? Evidence from a longitudinal study on depression in UK primary care.
How much change is enough? Evidence from a longitudinal study on depression in UK primary care.
复制标题
多少零钱才够？来自英国初级保健中抑郁症纵向研究的证据。
DOI：
10.1017/s0033291720003700
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发表时间：
2022-07
影响因子：
6.9
通讯作者：
Lewis, Glyn
中科院分区：
文献类型：
--
作者：
Kounali, Daphne;Button, Katherine S.;Lewis, Gemma;Gilbody, Simon;Kessler, David;Araya, Ricardo;Duffy, Larisa;Lanham, Paul;Peters, Tim J.;Wiles, Nicola;Lewis, Glyn
关键词：
患者健康问卷（PHQ-9），贝克抑郁量表（BDI-II）和广泛性焦虑障碍评估（GAD-7）被广泛用于评估抑郁和焦虑的干预措施。对患者有影响的抑郁症状的最小减少被称为最小临床重要差异（MCID）。几乎没有实证研究的MCID这些规模存在。一个前瞻性队列的400例患者在英国的初级保健进行了四次采访，间隔2周。在每个时间点，参与者完成了所有三份问卷和“全球变化评级”量表（GRS）。MCID估计依赖于根据GRS量表报告的改善估计的症状变化，根据临床访谈计划（CIS-R）按基线严重程度分层。对于中度基线严重程度，报告GRS改善的受试者在PHQ-9、BDI-II和GAD-7中分别降低了21%（95%置信区间（CI）−26.7至−14.9）、23%（95% CI −27.8至−18.0）和26.8%（95% CI −33.5至−20.1）。参与者更有可能报告改善的相应阈值分数分别为PHQ-9，BDI-II和GAD-7的-1.7，-3.5和-1.5分。症状较轻的患者需要更大幅度的降低基线百分比以支持改善。MCID表示这些量表中评分降低20%，是中重度症状患者的有用指南。如果治疗对患者有相同的效果，而不管基线严重程度如何，那些症状较轻的患者不太可能注意到获益。经费国立卫生研究院。
The Patient Health Questionnaire (PHQ-9), the Beck Depression Inventory (BDI-II) and the Generalised Anxiety Disorder Assessment (GAD-7) are widely used in the evaluation of interventions for depression and anxiety. The smallest reduction in depressive symptoms that matter to patients is known as the Minimum Clinically Important Difference (MCID). Little empirical study of the MCID for these scales exists. A prospective cohort of 400 patients in UK primary care were interviewed on four occasions, 2 weeks apart. At each time point, participants completed all three questionnaires and a ‘global rating of change’ scale (GRS). MCID estimation relied on estimated changes in symptoms according to reported improvement on the GRS scale, stratified by baseline severity on the Clinical Interview Schedule (CIS-R). For moderate baseline severity, those who reported improvement on the GRS had a reduction of 21% (95% confidence interval (CI) −26.7 to −14.9) on the PHQ-9; 23% (95% CI −27.8 to −18.0) on the BDI-II and 26.8% (95% CI −33.5 to −20.1) on the GAD-7. The corresponding threshold scores below which participants were more likely to report improvement were −1.7, −3.5 and −1.5 points on the PHQ-9, BDI-II and GAD-7, respectively. Patients with milder symptoms require much larger reductions as percentage of their baseline to endorse improvement. An MCID representing 20% reduction of scores in these scales, is a useful guide for patients with moderately severe symptoms. If treatment had the same effect on patients irrespective of baseline severity, those with low symptoms are unlikely to notice a benefit. Funding. National Institute for Health Research.