Brown C, Schulberg H C, Prigerson H G
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
Gen Hosp Psychiatry. 2000 Jul-Aug;22(4):242-50. doi: 10.1016/s0163-8343(00)00086-4.
This article describes a post-hoc analysis of clinical and psychosocial factors and beliefs about health associated with treatment outcome in a sample of depressed primary care patients (N=181) randomly assigned to a standardized treatment or physician's usual care (UC). Different factors were found to predict clinical outcomes for treatment modality [UC vs. interpersonal psychotherapy (IPT) or nortriptyline (NT)] and the type of outcome evaluated (i.e., depressive symptoms at 8 months or symptomatic and functional recovery at 8 months). Factors associated with treatment-specific outcomes are also described. Consistent with prior studies, lower depressive symptom severity at 8 months was associated with higher baseline functioning, minimal medical co-morbidity, race, and standardized pharmacologic or psychotherapeutic treatment. Additionally, an interaction between treatment modality and health locus of control indicated that individuals perceiving more self-control of their health and who received a standardized treatment experienced greater depressive symptom reduction at 8 months. Factors associated with symptomatic and functional recovery from the depressive episode were also examined. Patients who received a standardized treatment (IPT or NT) perceived greater control of their health and lacked a lifetime generalized anxiety disorder or panic disorder were more likely to recover by month 8 than those who received usual care. While clinical severity and treatment adequacy play an important role in both symptomatic improvement and full recovery from a depressive episode, other key factors such as health beliefs and non-depressive psychopathology also influence recovery.
本文描述了一项对181名随机分配至标准化治疗或医生常规护理（UC）的抑郁症初级护理患者样本中与治疗结果相关的临床、心理社会因素及健康观念的事后分析。研究发现，不同因素可预测治疗方式（UC对比人际心理治疗[IPT]或去甲替林[NT]）的临床结果以及所评估结果的类型（即8个月时的抑郁症状或8个月时的症状性及功能恢复）。文中还描述了与特定治疗结果相关的因素。与先前研究一致，8个月时较低的抑郁症状严重程度与较高的基线功能、最少的医疗合并症、种族以及标准化药物或心理治疗相关。此外，治疗方式与健康控制点之间的相互作用表明，那些认为自身对健康有更多自我控制且接受标准化治疗的个体在8个月时抑郁症状减轻得更多。研究还考察了与抑郁发作症状性及功能恢复相关的因素。接受标准化治疗（IPT或NT）、认为对自身健康有更强控制感且无终生广泛性焦虑症或恐慌症的患者，相比接受常规护理的患者，在8个月时更有可能康复。虽然临床严重程度和治疗充分性在抑郁发作的症状改善和完全康复中都起着重要作用，但其他关键因素，如健康观念和非抑郁性精神病理学，也会影响康复。
