Role of age, gender and marital status in prognosis for adults with depression: An individual patient data meta-analysis.
Role of age, gender and marital status in prognosis for adults with depression: An individual patient data meta-analysis.
复制标题
DOI：
10.1017/s2045796021000342
复制
发表时间：
2021-06-04
影响因子：
8.1
通讯作者：
Pilling S
中科院分区：
文献类型：
--
作者：
Buckman JEJ;Saunders R;Stott J;Arundell LL;O'Driscoll C;Davies MR;Eley TC;Hollon SD;Kendrick T;Ambler G;Cohen ZD;Watkins E;Gilbody S;Wiles N;Kessler D;Richards D;Brabyn S;Littlewood E;DeRubeis RJ;Lewis G;Pilling S
确定年龄、性别和婚姻状况是否与寻求初级保健治疗的成年抑郁症患者的预后有关。Medline、Embase、PsycINFO和Cochrane Central检索了从成立到2020年12月1日的随机对照试验（rct），这些试验是针对向全科医生寻求抑郁症治疗的成年人进行的，这些试验使用了修订的临床访谈计划，以便在临床预后因素的测量方面具有统一性，并报告了年龄、性别和婚姻状况。从所有9个符合条件的随机对照试验（N = 4864）中收集个体参与者数据。进行了两阶段随机效应荟萃分析，以确定：(i)年龄，（ii）性别和（iii）婚姻状况与基线后3 - 4,6 - 8时的抑郁症状之间的独立关联，<Vinod：请在文章中删除连续逗号>和基线后9-12个月，并在3-4个月缓解。使用QUIPS评估偏倚风险，使用GRADE评估质量。普洛斯彼罗注册号：CRD42019129512。预注册协议。在调整与预后相关的抑郁“障碍特征”（症状严重程度、抑郁和焦虑持续时间、共病性惊恐障碍和抗抑郁治疗史）之前或之后，没有证据表明年龄与预后之间存在关联。基线后3-4个月平均抑郁症状评分的差异= 0（95% CI: - 0.02至0.02）。没有证据表明男性和女性在基线后3-4个月或9-12个月的预后有差异，但男性在6-8个月的预后较差（男性与女性抑郁症状的百分比差异：15.08% (95% CI: 4.82至26.35)）。然而，这在很大程度上是由单一研究驱动的，该研究提供了6-8个月的数据，而不是其他时间点。此外，在调整抑郁“障碍特征”和就业状况后，几乎没有证据表明存在关联（12.23%(- 1.69至28.12)）。单身参与者(单身参与者抑郁症状的百分比差异：9.25% （95% CI: 2.78至16.13）或不再结婚的参与者（8.02% (95% CI: 1.31至15.18)）的预后比已婚参与者更差，即使在调整了抑郁“障碍特征”和所有可用的混杂因素后也是如此。临床医生和研究人员将继续常规记录年龄和性别，但尽管它们对抑郁症的发病率和患病率很重要，它们似乎对预后提供的信息很少。单身或不再结婚的患者的预后可能比已婚患者稍差。确保这在临床中与抑郁症“障碍特征”一起被常规记录可能很重要。
To determine whether age, gender and marital status are associated with prognosis for adults with depression who sought treatment in primary care. Medline, Embase, PsycINFO and Cochrane Central were searched from inception to 1st December 2020 for randomised controlled trials (RCTs) of adults seeking treatment for depression from their general practitioners, that used the Revised Clinical Interview Schedule so that there was uniformity in the measurement of clinical prognostic factors, and that reported on age, gender and marital status. Individual participant data were gathered from all nine eligible RCTs (N = 4864). Two-stage random-effects meta-analyses were conducted to ascertain the independent association between: (i) age, (ii) gender and (iii) marital status, and depressive symptoms at 3–4, 6–8,<Vinod: Please carry out the deletion of serial commas throughout the article> and 9–12 months post-baseline and remission at 3–4 months. Risk of bias was evaluated using QUIPS and quality was assessed using GRADE. PROSPERO registration: CRD42019129512. Pre-registered protocol . There was no evidence of an association between age and prognosis before or after adjusting for depressive ‘disorder characteristics’ that are associated with prognosis (symptom severity, durations of depression and anxiety, comorbid panic disorderand a history of antidepressant treatment). Difference in mean depressive symptom score at 3–4 months post-baseline per-5-year increase in age = 0(95% CI: −0.02 to 0.02). There was no evidence for a difference in prognoses for men and women at 3–4 months or 9–12 months post-baseline, but men had worse prognoses at 6–8 months (percentage difference in depressive symptoms for men compared to women: 15.08% (95% CI: 4.82 to 26.35)). However, this was largely driven by a single study that contributed data at 6–8 months and not the other time points. Further, there was little evidence for an association after adjusting for depressive ‘disorder characteristics’ and employment status (12.23% (−1.69 to 28.12)). Participants that were either single (percentage difference in depressive symptoms for single participants: 9.25% (95% CI: 2.78 to 16.13) or no longer married (8.02% (95% CI: 1.31 to 15.18)) had worse prognoses than those that were married, even after adjusting for depressive ‘disorder characteristics’ and all available confounders. Clinicians and researchers will continue to routinely record age and gender, but despite their importance for incidence and prevalence of depression, they appear to offer little information regarding prognosis. Patients that are single or no longer married may be expected to have slightly worse prognoses than those that are married. Ensuring this is recorded routinely alongside depressive ‘disorder characteristics’ in clinic may be important.