Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, WA, USA.
Depress Anxiety. 2010;27(1):19-26. doi: 10.1002/da.20613.
This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis.
This is a secondary analysis of data from a large primary care-based geriatric depression treatment trial that analyzes outcomes from the measurement-based stepped-care intervention arm (N=871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped-care algorithm, but would be less likely to reach remission and have a greater likelihood of re-emerging depression in the year after intervention.
Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression-free days during the 12-month intervention and in the postintervention year.
Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience.
本文分析了一项大型治疗试验干预组的数据，以证明临床严重程度、病程、合并症和治疗反应在患者预后中的重要性。
这是一项基于大型初级保健老年抑郁治疗试验数据的二次分析，该试验分析了基于测量的分级护理干预组（N=871 名患者）的结果，以确定：基线时抑郁严重程度的增加是否与其他与抑郁结局不良相关的因素有关，如双重抑郁、焦虑、医学疾病以及神经质和疼痛程度较高；以及抑郁严重程度增加的患者是否会根据分级护理算法接受更多的干预就诊和治疗试验，但更有可能在干预后一年复发抑郁。
抑郁严重程度的增加是缺乏缓解的有力预测指标，并与其他临床变量相关，这些变量与早期研究中缺乏缓解有关，如双重抑郁、焦虑、医学合并症、较高的神经质水平和慢性疼痛。严重程度较高的患者接受了明显更多的干预就诊、更多的抗抑郁药物治疗月数和更多的抗抑郁药物试验，但在 12 个月的干预和干预后一年中，无抑郁天数减少。
尽管接受了更高强度的治疗，但严重程度较高的患者临床结局较差。根据临床严重程度、疾病过程和治疗经验提出了一种新的抑郁分类。
