American University of Beirut, Lebanon.
J Affect Disord. 2012 Apr;138(1-2):86-95. doi: 10.1016/j.jad.2011.12.021. Epub 2012 Jan 30.
To identify distinct depressive symptom trajectories in the TORDIA study and determine their correlates.
Latent Class Growth Analysis (LCGA) using the Children's Depression Rating Scale-Revised (CDRS-R) through 72 weeks from intake.
3 classes were identified: (1) little change in symptomatic status ("NO"), comprising 24.9% of participants, with a 72-week remission rate of 25.3%; (2) slow, steady improvement ("SLOW"), comprising 47.9% of participants, with a remission rate of 60.0%, and (3) rapid symptom response ("GO"), comprising 27.2% of participants, with a remission rate of 85.7%. Higher baseline CDRS-R (p<0.001) and poorer functioning (p=0.03) were the strongest discriminators between NO and GO. Higher baseline CDRS (p<0.001) and scores on the Mania Rating Scale (MRS) (p=0.01) were the strongest discriminators between SLOW and GO. Other variables differentiating GO from both NO and from SLOW, were better baseline functioning, lower hopelessness, and lower family conflict. Both NO and SLOW showed increases on the MRS over time compared to GO (ps ≤ 0.04), and increasing MRS was strongly associated with lack of remission by 72 weeks (p=0.02).
High rate of open treatment by the end of the follow-up period creates difficulty in drawing clear inferences about the long-term impact of initial randomization.
Along with depressive severity, sub-syndromal manic symptoms, at baseline, and over time emerged as important predictors and correlates of poor outcome in this sample. Further research is needed on the treatment of severe depression, and on the assessment and management of sub-syndromal manic symptoms in treatment resistant depression.
在 TORDIA 研究中确定不同的抑郁症状轨迹，并确定其相关性。
使用儿童抑郁评定量表修订版（CDRS-R）通过 72 周的时间进行潜在类别增长分析（LCGA）。
确定了 3 个类别：（1）症状状态无明显变化（“NO”），占参与者的 24.9%，72 周缓解率为 25.3%；（2）缓慢而稳定的改善（“SLOW”），占参与者的 47.9%，缓解率为 60.0%，以及（3）快速症状反应（“GO”），占参与者的 27.2%，缓解率为 85.7%。较高的基线 CDRS-R（p<0.001）和较差的功能（p=0.03）是区分 NO 和 GO 的最强指标。较高的基线 CDRS（p<0.001）和躁狂评定量表（MRS）评分（p=0.01）是区分 SLOW 和 GO 的最强指标。其他区分 GO 与 NO 和 SLOW 的变量是基线功能更好、绝望感更低以及家庭冲突更少。与 GO 相比，NO 和 SLOW 在整个研究过程中 MRS 均呈上升趋势（p≤0.04），并且 MRS 的增加与 72 周时未缓解强烈相关（p=0.02）。
随访结束时高比例的开放治疗增加了对初始随机分组长期影响的明确推断的难度。
除了抑郁严重程度外，基线时和随时间推移出现的亚综合征躁狂症状也是该样本中预后不良的重要预测指标和相关性因素。需要进一步研究严重抑郁的治疗以及治疗抵抗性抑郁症中亚综合征躁狂症状的评估和管理。
