Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, United Kingdom.
J Clin Oncol. 2011 Nov 10;29(32):4307-12. doi: 10.1200/JCO.2011.34.8466. Epub 2011 Oct 11.
There is a need for high-quality evidence regarding the frequency, independent clinical associations, and longitudinal course of depression in patients with cerebral glioma.
This was a twin-center, prospective, observational cohort study with 6-month follow-up. Consenting adults with a new diagnosis of cerebral glioma received the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to diagnose major depressive disorder (MDD). Interviews occurred shortly after the start of radiotherapy (T1), with follow-up interviews 3 months later (T2) and 6 months later (T3). Independent associations between MDD and clinical variables were analyzed using logistic regression.
One hundred fifty-five patients participated. The frequency of MDD was 13.5% ± 5.4% at T1 (n = 155); 14.8% ± 6.7% at T2 (n = 108); and 6.8% ± 5.3% at T3 (n = 88). Overall, 32 individuals were diagnosed with MDD during the study period (20.6% ± 6.4%). Inter-rater diagnostic agreement for MDD was good (κ = 0.81; 95% CI, 0.60 to 1.00). Independent predictors of MDD were functional impairment (odds ratio, 3.9; 95% CI, 1.5 to 10.8) and a previous history of depression (odds ratio, 2.7; 95% CI, 0.99 to 7.3). MDD persisted for at least 3 months in half of the patients with adequate follow-up, but many depressed patients also dropped out of the study as a result of clinical deterioration.
In this longitudinal study, one in five patients with glioma developed clinical depression in the 6 months after starting radiotherapy. Patients with functional impairment or previous depression were at higher risk. MDD often persisted for at least 3 months. Clinicians should seek and treat depression in adults with glioma.
需要高质量的证据来描述脑胶质瘤患者中抑郁的频率、独立的临床关联和纵向病程。
这是一项为期 6 个月的随访的双中心、前瞻性、观察性队列研究。新诊断为脑胶质瘤的同意成年人接受精神疾病诊断和统计手册第四版的结构性临床访谈，以诊断重度抑郁症（MDD）。访谈在放射治疗开始后不久（T1）进行，随后在 3 个月（T2）和 6 个月（T3）进行随访访谈。使用逻辑回归分析 MDD 与临床变量之间的独立关联。
共有 155 名患者参与。T1 时 MDD 的频率为 13.5%±5.4%（n=155）；T2 时为 14.8%±6.7%（n=108）；T3 时为 6.8%±5.3%（n=88）。总的来说，在研究期间有 32 名个体被诊断为 MDD（20.6%±6.4%）。MDD 的观察者间诊断一致性良好（κ=0.81；95%置信区间，0.60 至 1.00）。MDD 的独立预测因子为功能障碍（优势比，3.9；95%置信区间，1.5 至 10.8）和先前的抑郁史（优势比，2.7；95%置信区间，0.99 至 7.3）。在有足够随访的患者中，有一半的 MDD 至少持续 3 个月，但许多抑郁患者也因临床恶化而退出研究。
在这项纵向研究中，五分之一的脑胶质瘤患者在开始放射治疗后的 6 个月内出现临床抑郁。有功能障碍或既往抑郁史的患者风险更高。MDD 通常至少持续 3 个月。临床医生应在脑胶质瘤成年患者中寻找并治疗抑郁。
