Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and Butler Hospital, Providence, RI 02906, USA.
Compr Psychiatry. 2010 Sep-Oct;51(5):497-503. doi: 10.1016/j.comppsych.2010.02.001. Epub 2010 Mar 12.
The aim of the current study was to evaluate family functioning, social support, and functional impairment as predictors of mood symptoms 1 year after acute phase treatment of bipolar I disorder. This study builds upon the extant literature by evaluating these putative psychosocial risk factors simultaneously to determine whether they account for unique variance in clinical outcomes.
Patients (N = 92) were recruited from hospital settings during an acute mood episode to participate in pharmacologic or combined family and pharmacologic interventions. The Modified Hamilton Rating Scale for Depression, Bech-Rafaelson Mania Scale, Family Assessment Device, Interpersonal Support Evaluation List, and UCLA Social Attainment Survey were administered at acute phase treatment completion and again at 1-year follow-up. Controlling for mood symptom severity at acute phase treatment completion, multiple regression analyses were used to examine longitudinal associations between the psychosocial variables and subsequent depressive and manic symptoms.
None of the aforementioned psychosocial variables predicted manic symptomatology, and social support alone emerged as a unique predictor of depression at the 1-year follow-up. Effects of social support were moderated by recovery status, such that the strength of association between social support and subsequent depression was stronger for those who had not fully recovered during the acute phase of treatment than for those who had.
Low levels of social support at acute phase treatment completion, especially in concert with residual symptomatology, may place individuals with bipolar I disorder at risk for subsequent depressive symptoms. These data suggest that maintenance therapies focused on improving level of social support might be especially important to consider in the management of bipolar depression, and add to a growing literature focused on unique vs shared effects of psychosocial risk factors for poor illness course in bipolar disorder.
本研究旨在评估家庭功能、社会支持和功能障碍作为双相 I 型障碍急性治疗后 1 年情绪症状的预测因素。本研究通过同时评估这些潜在的心理社会风险因素，以确定它们是否解释了临床结局的独特差异，从而建立在现有文献的基础上。
从医院环境中招募处于急性情绪发作期的患者（N=92），以参与药物或联合家庭和药物干预。在急性治疗完成时和 1 年随访时，分别使用改良汉密尔顿抑郁评定量表、贝克-拉斐尔森躁狂量表、家庭评估工具、人际支持评估量表和加州大学洛杉矶分校社会成就调查进行评估。在控制急性治疗完成时情绪症状严重程度的情况下，多元回归分析用于检查心理社会变量与随后的抑郁和躁狂症状之间的纵向关联。
上述心理社会变量均不能预测躁狂症状，只有社会支持是 1 年随访时抑郁的唯一预测因素。社会支持的作用受到恢复状态的调节，即社会支持与随后抑郁之间的关联强度在急性治疗阶段未完全恢复的患者中比在已恢复的患者中更强。
急性治疗完成时社会支持水平较低，尤其是与残留症状并存，可能使双相 I 型障碍患者面临随后发生抑郁症状的风险。这些数据表明，专注于提高社会支持水平的维持治疗可能对双相抑郁的管理尤为重要，并为关注心理社会风险因素对双相障碍不良病程的独特和共同影响的不断增长的文献做出了贡献。
