Vittengl Jeffrey R, Clark Lee Anna, Jarrett Robin B
Department of Psychology, Truman State University, Kirksville, MO 63501-4221, United States.
J Affect Disord. 2009 Jan;112(1-3):135-43. doi: 10.1016/j.jad.2008.04.004. Epub 2008 Jun 9.
Associations between major depressive disorder (MDD) and psychosocial functioning are incompletely understood across time and during continuation phase cognitive therapy (C-CT). We examined the validity of the Range of Impaired Functioning Tool (RIFT; [Leon, A.C., Solomon, D.A., Mueller, T.I., Turvey, C.L., Endicott, J., Keller, M.B., 1999. The Range of Impaired Functioning Tool (LIFE-RIFT): A brief measure of functional impairment. Psychol. Med. 29, 869-878.]) as a measure of psychosocial functioning and its relations to depressive symptoms in C-CT and assessment-only control conditions.
Outpatients with recurrent MDD who responded to acute-phase cognitive therapy (A-CT) were randomized to 8 months of C-CT (n=41) or assessment-only (n=43) and followed 16 additional months [Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. Preventing recurrent depression using cognitive therapy with and without a continuation phase: A randomized clinical trial. Arch. Gen. Psychiatry 58, 381-388.]. Interviewers rated depressive symptoms and psychosocial functioning monthly. Patients completed additional self-reports.
The RIFT converged appropriately with other measures of psychosocial functioning, depressive symptoms, cognitive content, and personality. About half (55%) of patients were psychosocially "well" (RIFT< or =8) during the first month post-A-CT. C-CT improved psychosocial functioning only transiently compared to the assessment control. Examined prospectively, depressive symptom level did not predict monthly changes in psychosocial functioning significantly, whereas psychosocial dysfunction level predicted monthly changes in depressive symptoms and relapse/recurrence.
Findings may not generalize to other patient populations, treatments, and assessment methods. The cross-lagged correlational data structure allows only tentative conclusions about the causal effect of psychosocial functioning on depressive symptoms.
The RIFT is a valid measure of psychosocial functioning among responders to A-CT for depression. After such response, deteriorations in psychosocial functioning may signal imminent major depressive relapse/recurrence and provide targets for change during treatments focused on relapse/recurrence prevention.
重度抑郁症（MDD）与社会心理功能之间的关联在不同时间以及持续阶段认知疗法（C-CT）期间尚未完全明确。我们检验了功能受损范围工具（RIFT；[Leon, A.C., Solomon, D.A., Mueller, T.I., Turvey, C.L., Endicott, J., Keller, M.B., 1999. 功能受损范围工具（LIFE-RIFT）：功能损害的简短测量方法。《心理医学》29, 869 - 878.]）作为社会心理功能测量工具的有效性，及其在C-CT和仅评估对照条件下与抑郁症状的关系。
对急性期认知疗法（A-CT）有反应的复发性MDD门诊患者被随机分为接受8个月C-CT组（n = 41）或仅评估组（n = 43），并随访额外16个月[Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. 使用有或无持续阶段的认知疗法预防复发性抑郁症：一项随机临床试验。《普通精神病学文献》58, 381 - 388.]。访谈者每月对抑郁症状和社会心理功能进行评分。患者完成额外的自我报告。
RIFT与社会心理功能、抑郁症状、认知内容和人格的其他测量方法适度一致。在A-CT后第一个月，约一半（55%）的患者社会心理功能“良好”（RIFT≤8）。与评估对照相比，C-CT仅短暂改善了社会心理功能。前瞻性研究发现，抑郁症状水平并未显著预测社会心理功能的每月变化，而社会心理功能障碍水平预测了抑郁症状的每月变化以及复发/再发情况。
研究结果可能不适用于其他患者群体、治疗方法和评估方法。交叉滞后相关数据结构仅允许对社会心理功能对抑郁症状的因果效应得出初步结论。
RIFT是抑郁症A-CT反应者社会心理功能的有效测量工具。在这种反应之后，社会心理功能的恶化可能预示着即将发生的重度抑郁复发/再发，并为专注于预防复发/再发的治疗提供改变目标。
