Raue Patrick J, Schulberg Herbert C, Heo Moonseong, Klimstra Sibel, Bruce Martha L
Department of Psychiatry, Weill Cornell Medical College, Cornell University, White Plains, NY 10605, USA.
Psychiatr Serv. 2009 Mar;60(3):337-43. doi: 10.1176/ps.2009.60.3.337.
The authors examined the association of treatment preferences with treatment initiation, adherence, and clinical outcome among nonsenior adult and senior primary care patients with depression.
Sixty primary care participants meeting DSM-IV criteria for major depression were randomly assigned to receive treatment congruent or incongruent with their primary stated preference. Participants received either 20 weeks of escitalopram, with monitoring by a care manager, or 12 weekly sessions of interpersonal psychotherapy followed by two monthly booster sessions. Adherence to treatment and depression severity were reassessed at weeks 4, 8, 12, and 24.
Participants expressed stronger preferences for psychotherapy than for antidepressant medication. Preference strength was a more sensitive measure of outcome than was congruence versus incongruence of preference with the assigned treatment. Across age groups, preference strength was significantly associated with treatment initiation and 12-week adherence rate but not with depression severity or remission.
A continuous measure of preference strength may be a more useful measure in clinical practice than preferences per se. Future research should focus on whether and how greater facilitation of the treatment decision-making process between patient and clinician influences clinical outcome.
作者研究了非老年成人及老年初级保健抑郁症患者的治疗偏好与治疗启动、依从性及临床结局之间的关联。
60名符合《精神疾病诊断与统计手册》第四版（DSM-IV）重度抑郁症标准的初级保健参与者被随机分配接受与其最初表明的偏好一致或不一致的治疗。参与者接受20周的艾司西酞普兰治疗，并由一名护理经理进行监测，或者接受12次每周一次的人际心理治疗，随后每月进行两次强化治疗。在第4、8、12和24周重新评估治疗依从性和抑郁严重程度。
参与者对心理治疗的偏好强于抗抑郁药物。偏好强度比偏好与指定治疗的一致性或不一致性更能敏感地衡量结局。在各年龄组中，偏好强度与治疗启动和12周依从率显著相关，但与抑郁严重程度或缓解情况无关。
在临床实践中，偏好强度的连续测量可能比偏好本身更有用。未来的研究应关注患者与临床医生之间治疗决策过程的更大便利化是否以及如何影响临床结局。
