Neugebauer Richard, Kline Jennie, Markowitz John C, Bleiberg Kathryn L, Baxi Laxmi, Rosing Mark A, Levin Bruce, Keith Jessica
Epidemiology of Developmental Brain Disorders Department, New York State Psychiatric Institute, G H Sergievsky Center, Columbia University, New York, NY 10032, USA.
J Clin Psychiatry. 2006 Aug;67(8):1299-304. doi: 10.4088/jcp.v67n0819.
Miscarriage, which occurs in 10% to 20% of clinically recognized pregnancies, is associated with an increased risk for subsyndromal depression. We examined whether Interpersonal Counseling (IPC) was superior to treatment as usual (TAU) in reducing subsyndromal depression among miscarrying women and, secondarily, superior to TAU in improving role functioning.
Nineteen of 20 eligible women participated in a randomized controlled trial of 1 to 6 weekly telephone sessions of IPC versus TAU, which consisted of whatever lay counseling or professional care women sought on their own initiative, from October 2001 to April 2002. The 2 trial arms were compared on mean within-subject change in Hamilton Rating Scale for Depression-17-item (HAM-D-17) scores and in role functioning scale scores (a 5-item modification of the 36-item Medical Outcomes Study questionnaire) from baseline to post-intervention.
In the primary intent-to-treat analysis, the baseline mean HAM-D-17 scores were 18.0 (SD +/- 8.4) and 14.8 (SD +/- 6.6) in the IPC (N = 10) and TAU (N = 9) arms, respectively; post-intervention, the corresponding means were 11.6 (SD +/- 8.2) and 12.9 (SD +/- 8.3). The mean within-subject decline in HAM-D-17 scores was significantly greater in the IPC (6.4) than in the TAU (1.9) arm (difference in mean within-subject score decline, adjusted for design features, baseline HAM-D-17 scores and for baseline ethnic imbalance between study arms, 6.2 [95% CI = 0.4 to 12.0]). In a subordinate completers' analysis (N = 15), the corresponding mean decline and difference in adjusted mean decline were 8.0, 2.4, and 6.7 (95% CI = 0.4 to 13.1), respectively. Treatment was unrelated to improved role functioning.
The efficacy of telephone-administered IPC for subsyndromal depression after miscarriage warrants testing in a full-scale randomized controlled trial.
流产发生于10%至20%临床确诊的妊娠中，与亚综合征性抑郁风险增加相关。我们研究了人际咨询（IPC）在降低流产女性亚综合征性抑郁方面是否优于常规治疗（TAU），其次，在改善角色功能方面是否优于TAU。
20名符合条件的女性中有19名参加了一项随机对照试验，该试验于2001年10月至2002年4月进行，将每周1至6次的IPC电话咨询与TAU进行对比，TAU包括女性自主寻求的任何非专业咨询或专业护理。比较两个试验组从基线到干预后的汉密尔顿抑郁量表17项（HAM-D-17）评分的受试者内平均变化以及角色功能量表评分（36项医学结局研究问卷的5项修改版）。
在主要的意向性分析中，IPC组（N = 10）和TAU组（N = 9）的基线HAM-D-17平均评分分别为18.0（标准差±8.4）和14.8（标准差±6.6）；干预后，相应的平均值分别为11.6（标准差±8.2）和12.9（标准差±8.3）。IPC组（6.4）的HAM-D-17评分受试者内平均下降幅度显著大于TAU组（1.9）（受试者内平均评分下降差异，根据设计特征、基线HAM-D-17评分以及研究组间基线种族不平衡进行调整，为6.2 [95%可信区间 = 0.4至12.0]）。在次要的完成者分析（N = 15）中，相应的平均下降和调整后平均下降差异分别为8.0、2.4和6.7（95%可信区间 = 0.4至13.1）。治疗与角色功能改善无关。
电话形式的IPC对流产后亚综合征性抑郁的疗效值得在全面的随机对照试验中进行检验。
