Interpersonal therapy for depression in Breast Cancer

描述（由申请人提供）：抑郁症和症状在乳腺癌患者中普遍存在，在癌症治疗过程中恶化，在癌症治疗后持续存在，显著影响生活质量，降低对癌症治疗的依从性和生存率。然而，目前还没有针对乳腺癌患者抑郁症的既定治疗方法。随着癌症存活越来越普遍，迫切需要发展经验基础，为这一人群提供有效的循证治疗。我们提出一项随机临床试验，比较人际心理治疗（IPT）、问题解决治疗（PST）和短暂支持性心理治疗（BSP）在缓解乳腺癌DSM-IV重度抑郁症（MDD）患者抑郁症状和改善生活质量方面的疗效。IPT是一种人工的、有时间限制的治疗方法，在治疗重度抑郁症方面一再显示出疗效，并且在年龄范围、文化、形式和递送方式方面具有显著的灵活性和有效性。PST是一种简短的，手动形式的认知行为疗法（CBT），已被用于治疗癌症患者的抑郁症，并显示出非常有希望的结果。BSP是一种相对非结构化的心理治疗，通常用于临床实践，侧重于患者的影响。它通过仔细倾听和同情病人，确认和鼓励病人的情绪宽容，建立一个强大的治疗联盟。它在患有癌症和其他疾病的抑郁症患者身上显示出了令人鼓舞的效果。除了改善抑郁症状外，还将检查社会人口统计学特征、临床因素、抑郁症治疗依从性和结局护理之间的关系。每种情况的患者将在16周内接受12次治疗，并将再随访4个月以检查反应的稳定性。我们的模型是基于现有文献，我们在乳腺癌患者生存护理方面的长期经验，提出的治疗方法的理论吸引力和前景数据，以及广泛的初步数据。此外，拟议的研究将通过检查治疗结果的中介和调节因子，深入了解影响关键结果的因素。通过研究一个基于理论的治疗模式，以及来自一个富有成效的研究团队的有希望的试点数据，我们相信我们可以帮助为抑郁症乳腺癌患者提供有效治疗提供迫切需要的经验基础。公共卫生相关性：尽管DSM-IV重度抑郁症（MDD）在乳腺癌患者中的患病率和不良后果，但目前尚无确定的治疗方法。我们提出一项随机临床试验，比较人际心理治疗（IPT）、问题解决治疗（PST）和短暂支持治疗（BSP）在改善乳腺癌重度抑郁症患者抑郁症状和生活质量方面的疗效。我们希望这项研究的结果将有助于为这一人群建立有效的、基于证据的治疗急需的经验基础。

DESCRIPTION (provided by applicant): Depressive disorders and symptoms are prevalent in patients with breast cancer, worsen over the course of cancer treatment, persist after cancer therapy, significantly impair quality of life, and decrease adherence to cancer therapy and survival. Yet, there are no established treatments for depression in breast cancer patients. As surviving cancer becomes increasingly common, there is an urgent need to develop an empirical basis to provide effective, evidence-based treatments to this population. We propose a randomized clinical trial to compare the efficacy of Interpersonal Psychotherapy (IPT), Problem-Solving Therapy (PST), and Brief Supportive Psychotherapy (BSP) in alleviating depressive symptoms and improving quality of life for breast cancer patients with DSM-IV major depressive disorder (MDD). IPT, a manualized, time-limited therapy, has shown repeated efficacy in treating MDD, and remarkable flexibility and efficacy across age ranges, cultures, formats, and modes of delivery. PST is a brief, manualized form of cognitive-behavioral therapy (CBT) that has been adapted to treat depression in cancer patients and shown highly promising results. BSP is a relatively unstructured psychotherapy commonly used in clinical practice that focuses on the patient's affect. It builds a strong therapeutic alliance through listening carefully and empathically to the patient, validating and encouraging toleration of the patient's emotions. It has shown promising results in depressed individuals with cancer and other medical illnesses. In addition to improvement in depressive symptoms, relationships between sociodemographic characteristics, clinical factors, depression treatment adherence, and outcomes care will be examined. Patients in each condition will receive 12 therapy sessions within a 16-week period, and will be followed for another 4 months to examine the stability of response. Our model is based on the existing literature, our long-standing experience in survivorship care of breast cancer patients, the theoretical appeal and promising data of the proposed treatments, and a broad range of preliminary data. In addition, the proposed study will yield insight into factors that influence key outcomes by examining mediators and moderators of treatment outcome. By investigating a theoretically-based treatment model with promising pilot data from a productive research team, we believe we can help generate the urgently needed empirical foundations for the provision of effective treatment to depressed breast cancer patients. PUBLIC HEALTH RELEVANCE: Despite the prevalence and adverse consequences of DSM-IV major depressive disorder (MDD) for breast cancer patients, no established treatments exist. We propose a randomized clinical trial to compare the efficacy of Interpersonal Psychotherapy (IPT), Problem-Solving Therapy (PST) and Brief Supportive Therapy (BSP) in improving depressive symptoms and quality of life among breast cancer patients with MDD. We hope that the results of this study will help to build the urgently needed empirical basis for effective, evidence-based treatments for this population.