Bosworth Hayden B, Hays Judith C, George Linda K, Steffens David C
Health Services Research and Development, Building 16 Rm. 70, Durham VAMC, 508 Fulton Street, Durham, NC 27705, USA.
Int J Geriatr Psychiatry. 2002 Mar;17(3):238-46. doi: 10.1002/gps.590.
This study examined psychosocial and clinical predictors of depression non-remittance among a sample of initially clinically depressed elders.
Incident and prevalent unipolar depression cases (n = 166) were enrolled into the MHCRC for the Study of Depression in Late Life and followed for 12 months while undergoing treatment using a standardized algorithm. The outcome was remission vs non-remission (<6 vs > 7 on the Montgomery-Asberg Depression Rating Scale (MADRS)) at one-year follow-up. Baseline predictor variables included psychosocial factors, such as four domains of social support, basic and instrumental activities of daily living (ADLs), and clinical factors, which included use of ECT, past history of depression, comorbidities, and antidepressant treatment.
At one-year follow-up, 45% of the sample was in remission based upon MADRS scores. In bivariate analyses, non-remitted patients were more likely at baseline to use benzodiazepines, anxiolytic/sedatives, and/or MAO inhibitors than patients in remission, and have more depressive episodes. Among psychosocial factors, non-remitted patients had at baseline, more ADL and IADL problems and decreased subjective social support as compared to patients in remission. In logistic regression analyses more depression episodes, using anxiolytic/sedatives, more IADL problems and decreased subjective social support predicted poor depression outcome after one-year.
While clinical and diagnostic variables were related to improvement, baseline psychosocial factors were also important.
本研究在一组初始患有临床抑郁症的老年人样本中，考察了抑郁症未缓解的社会心理及临床预测因素。
将新发和现患的单相抑郁症病例（n = 166）纳入晚年抑郁症研究的MHCRC，并在使用标准化算法进行治疗的同时随访12个月。结局指标为一年随访时的缓解与未缓解情况（蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评分<6分为缓解，>7分为未缓解）。基线预测变量包括社会心理因素，如社会支持的四个领域、基本日常生活活动和工具性日常生活活动（ADL），以及临床因素，包括是否使用ECT、既往抑郁病史、合并症和抗抑郁治疗。
在一年随访时，根据MADRS评分，45%的样本处于缓解状态。在双变量分析中，与缓解的患者相比，未缓解的患者在基线时更有可能使用苯二氮䓬类药物、抗焦虑/镇静剂和/或单胺氧化酶抑制剂，且有更多的抑郁发作。在社会心理因素方面，与缓解的患者相比，未缓解的患者在基线时存在更多的ADL和IADL问题，主观社会支持减少。在逻辑回归分析中，更多的抑郁发作、使用抗焦虑/镇静剂、更多的IADL问题和主观社会支持减少预示着一年后抑郁结局不佳。
虽然临床和诊断变量与改善情况有关，但基线社会心理因素也很重要。
