Molenaar Pieter J, Dekker Jack, Van Rien, Hendriksen Marielle, Vink Aukje, Schoevers Robert A
Mentrum Mental Health Organization, Amsterdam, The Netherlands.
Depress Anxiety. 2007;24(8):553-62. doi: 10.1002/da.20254.
The existence of an overall association between severity of depression and level of social functioning is well documented. To increase the probability of a long-term recovery, a normal level of social functioning is essential. It is currently unknown whether combined therapy has a better outcome than pharmacotherapy with regard to social functioning. In a 6-month randomized clinical trial in outpatients with major depression, all patients studied had a baseline score of at least 14 points on the 17-item Hamilton Depression Rating Scale (HDRS). The two conditions consist of pharmacotherapy (PhT) (N=84) and combined therapy (CoT), pharmacotherapy plus 16 sessions of short psychodynamic supportive psychotherapy (N=83). Efficacy was assessed using the 17-item HDRS, the Clinical Global Impression (CGI) Severity and Improvement scales, the Depression subscale of the Symptom Checklist-90 (SCL-90), the Quality of Life Depression Scale (QLDS), more the Groningen Social Disability Schedule (GSDS). Severity of depression decreased significantly (on the SCL-90 Depression subscale and the QLDS) more in the CoT condition. A larger improvement in social functioning was demonstrated for remitted patients than for nonremitted patients. The number of dimensions of social functioning that had improved significantly was higher in CoT than in PhT. There was a moderate advantage of the CoT condition on both depressive symptoms and level of social functioning in comparison with PhT. We also found a positive association between depression severity and level of social functioning.
抑郁严重程度与社会功能水平之间存在总体关联，这一点已有充分记录。为提高长期康复的可能性，正常的社会功能水平至关重要。目前尚不清楚在社会功能方面，联合治疗是否比药物治疗效果更好。在一项针对重度抑郁症门诊患者的为期6个月的随机临床试验中，所有研究对象在17项汉密尔顿抑郁量表（HDRS）上的基线得分至少为14分。两种治疗方案分别为药物治疗（PhT）（N = 84）和联合治疗（CoT），即药物治疗加16节短期心理动力支持性心理治疗（N = 83）。使用17项HDRS、临床总体印象（CGI）严重程度和改善量表、症状自评量表90（SCL - 90）的抑郁分量表、生活质量抑郁量表（QLDS）以及格罗宁根社会残疾评定量表（GSDS）评估疗效。在联合治疗组中，抑郁严重程度（在SCL - 90抑郁分量表和QLDS上）显著降低。与未缓解的患者相比，缓解的患者在社会功能方面有更大改善。联合治疗组中社会功能显著改善的维度数量高于药物治疗组。与药物治疗相比，联合治疗组在抑郁症状和社会功能水平方面均有适度优势。我们还发现抑郁严重程度与社会功能水平之间存在正相关。
