Depression Remission Rates Among Older Black and White Adults: Analyses From the IRL-GREY Trial.
Depression Remission Rates Among Older Black and White Adults: Analyses From the IRL-GREY Trial.
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DOI：
10.1176/appi.ps.201400480
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发表时间：
2015-12-01
期刊：
影响因子：
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通讯作者：
Reynolds CF 3rd
中科院分区：
文献类型：
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作者：
Hall CA;Simon KM;Lenze EJ;Dew MA;Begley A;Butters MA;Blumberger DM;Stack JA;Mulsant B;Reynolds CF 3rd
本研究探讨了老年黑人和白人重度抑郁症患者在文拉法辛开放治疗和支持治疗期间缓解率或减损率是否存在差异。47名黑人（10%）和412名白人(90%)≥60岁的成年人在nimh赞助的多地点、随机、安慰剂对照增强试验的初始阶段使用开放标签文拉法辛缓释（高达300mg/天）治疗12-14周。参与者是寻求帮助的老年人，他们患有非精神病性重度抑郁症（单次或反复发作），来自专业精神卫生诊所、初级保健实践、广告和研究项目。缓解定义为在12周结束时连续两次进行蒙哥马利-阿斯伯格抑郁量表评分≤10分。Kaplan-Meier曲线显示退出时间和初始缓解时间。Cox比例风险模型用于评估减员率和缓解率的差异。与白人参与者相比，黑人参与者有更多的基线医疗合并症，更差的身体健康相关生活质量和更差的认知功能。在参加研究之前，白人比黑人更有可能接受了充分的抗抑郁药物和心理治疗试验。基线抑郁严重程度、抑郁持续时间、发病年龄和复发史在两组之间没有差异。黑人和白人服用文拉法辛的最终剂量、减少率和缓解率相似。两组之间的副作用具有可比性。尽管有更多的医疗合并症，更低的认知功能，以及更少的抗抑郁药物和心理治疗，黑人参与者不太可能停止抗抑郁药物治疗，并且经历了与白人参与者相当的缓解率。
This study explored whether older black and white adults with major depressive disorder differ in rates of remission or attrition during open-treatment with venlafaxine and supportive care. 47 black (10%) and 412 white (90%) adults ≥ age 60 were treated using open-label venlafaxine extended-release (up to 300mg/day) for 12-14 weeks during the initial phase of an NIMH-sponsored, multisite, randomized, placebo-controlled augmentation trial. Participants were help-seeking elders with non-psychotic major depressive disorder (single or recurrent episode) referred from specialty mental health clinics, primary care practices, advertisements and research programs. Remission was defined as a Montgomery-Asberg Depression Scale score of ≤10 for two consecutive assessments at the end of 12 weeks. Kaplan-Meier curves were employed to display time to drop out and time to initial remission. Cox Proportional Hazard models were used to assess differences in attrition and remission rates. Black participants had greater baseline medical comorbidity, worse physical-health related quality of life and poorer cognitive function compared with white participants. Whites were more likely than blacks to have received an adequate trial of antidepressant and psychotherapy before entering the study. Baseline depression severity, duration of depression, age of onset, and recurrence history did not differ between the two groups. Blacks and whites had similar final doses of venlafaxine, rates of attrition and remission. Side effect profiles were comparable between the two groups. Despite greater medical comorbidity, lower cognitive function, and less adequate prior antidepressant and psychotherapy exposure, black participants were no more likely to discontinue antidepressant pharmacotherapy, and experienced a rate of remission comparable to white participants.