Reducing residual depressive symptoms with web-based Mindful Mood Balance

通过基于网络的正念情绪平衡减少残余抑郁症状

• 批准号: 8758265
• 负责人: Zindel Segal
• 金额: $ 55.75万
• 依托单位: UNIVERSITY OF TORONTO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-16 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8758265
• 关键词: Acute; Address; Adopted; Adult; Affective; Aftercare; American; Antidepressive Agents; Caring; Chronic; Clinical; Clinical Practice Guideline; Colorado; Communities; Controlled Study; Data; Data Collection; Depressed mood; Disease remission; Educational process of instructing; Effectiveness; Electronic Mail; Electronics; Equilibrium; Evaluation; Funding; Home environment; Intervention; Knowledge; Maintenance; Major Depressive Disorder; Manuals; Measures; Mediating; Mediation; Medical; Medical History; Mental Depression; Mental Health; Methods; Moods; Online Systems; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Persons; Pharmacotherapy; Phase; Primary Health Care; Prophylactic treatment; Psyche structure; Quality of life; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recording of previous events; Recovery; Recurrence; Relapse; Relative (related person); Reliance; Reporting; Research; Research Infrastructure; Residual state; Resolution; Risk; Self Management; Services; Severities; Survival Analysis; Symptoms; System; Telephone; Testing; Thinking; Time; Training; Treatment Effectiveness; aged; base; clinically significant; cost; depressive symptoms; design; dysphoria; emotion regulation; evidence base; experience; falls; follow-up; functional disability; improved functioning; innovation; interest; medical specialties; meetings; member; mindfulness; mindfulness based cognitive therapy; peer; programs; prophylactic; public health relevance; satisfaction; skills; social; success; theories; therapy design; treatment as usual; virtual

DESCRIPTION (provided by applicant): Residual depressive symptoms (RDS) following remission of major depressive disorder (MDD) are reported by 80-90% of adults receiving first-line antidepressant pharmacotherapy and carry an elevated risk for a chronic course of illness, rapid relapse and functional impairment (Nierenberg et al., 2010). Strategies for managing residual symptoms, however, have met with mixed success (Fava et al., 2007). Mindful Mood Balance (MMB; R34 MH0877223) is an individually tailored, web-based treatment designed to train remitted depressed patients to disengage from dysphoria-activated depressogenic thinking that perpetuates RDS and increases risk for relapse/recurrence. MMB was developed to increase access to Mindfulness-Based Cognitive Therapy (MBCT; R01 MH066992), an empirically supported prophylactic group treatment that can be easily sequenced with acute phase antidepressant pharmacotherapy. Results from our open trial of MMB (N=100) showed an effect size of d=1.09 for pre to post treatment reductions in depression scores among patients with RDS and d=1.54 in a quasi-experimental comparison to patients receiving usual care, with an on average reduction of 1.98 points on the PHQ-9 for MMB patients. We now propose a pragmatic randomized clinical trial of MMB to evaluate its effectiveness in reducing RDS in recurrently depressed patients. Patients will be members of Kaiser-Permanente Colorado (N = 460), aged 18 to 75, who score >5 and <9 on the PHQ-9, in remission from MDD and will be randomized 1:1 to either the usual depression care pathway (DepCare) or Mindful Mood Balance (MMB)+DepCare. We plan to test whether patients receiving MMB+DepCare will show greater reductions in RDS at both 8 week and 12 months follow up, than those receiving DepCare alone. We are also interested in examining whether fewer patients in MMB+DepCare will relapse over the follow up and will have higher end state functioning and quality of life. In order to examine the costs associated with adding this online treatment to the Depression Care Pathways at KPCO, we will calculate the marginal costs per additional number of depression free days (DFDs) for patients. Resolution of RDS can reduce the enormous personal and social costs experienced by Americans with this persistent symptom burden.

描述（由申请人提供）：接受一线抗抑郁药物治疗的成年人中有 80-90% 报告重度抑郁症 (MDD) 缓解后残留抑郁症状 (RDS)，并且慢性病程、快速复发和功能障碍的风险较高（Nierenberg 等，2010）。然而，管理残余症状的策略却取得了不同程度的成功（Fava 等，2007）。正念情绪平衡（MMB；R34 MH0877223）是一种个性化的、基于网络的治疗方法，旨在训练缓解的抑郁症患者摆脱由烦躁不安激活的抑郁思维，这种思维使 RDS 持续存在并增加复发/复发的风险。 MMB 的开发是为了增加基于正念的认知疗法（MBCT；R01 MH066992）的可及性，这是一种经验支持的预防性团体治疗，可以轻松地与急性期抗抑郁药物疗法进行排序。我们的 MMB 开放试验 (N=100) 结果显示，RDS 患者治疗前后抑郁评分降低的效应大小为 d=1.09，与接受常规护理的患者进行准实验比较，效果大小为 d=1.54，MMB 患者的 PHQ-9 平均降低 1.98 分。我们现在提出一项 MMB 的实用随机临床试验，以评估其在减少复发性抑郁症患者 RDS 方面的有效性。患者将是 Kaiser-Permanente Colorado 的成员 (N = 460)，年龄在 18 至 75 岁之间，PHQ-9 得分 >5 和 <9，处于 MDD 缓解期，并将按 1:1 随机分配至常规抑郁症护理途径 (DepCare) 或正念情绪平衡 (MMB)+DepCare。 我们计划测试接受 MMB+DepCare 的患者在 8 周和 12 个月的随访中是否会比单独接受 DepCare 的患者表现出更大的 RDS 降低。我们还有兴趣检查 MMB+DepCare 中的患者在随访过程中是否会出现更少的复发，并且具有更高的最终状态功能和生活质量。为了检查将这种在线治疗添加到 KPCO 抑郁症护理路径中的相关成本，我们将计算患者每增加无抑郁天数 (DFD) 的边际成本。 RDS 的解决可以减少患有这种持续症状负担的美国人所经历的巨大个人和社会成本。