Forbes Erika E, Stepp Stephanie D, Dahl Ronald E, Ryan Neal D, Whalen Diana, Axelson David A, Birmaher Boris, Silk Jennifer S
University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
J Child Adolesc Psychopharmacol. 2012 Feb;22(1):37-47. doi: 10.1089/cap.2011.0085.
OBJECTIVE: Response to treatment in child and adolescent affective disorders is variable, with limited ability of any one treatment to improve outcome across patients. Unfortunately, we know little about the factors that explain this variability in treatment response. Individual differences in the social and affective dynamics of daily life could help to elucidate the characteristics of youth who respond to treatment. METHODS: We used ecological momentary assessment of negative affect, positive affect, and companions in natural settings over 4 days in a sample of young people with depressive and anxiety disorders who participated in an 8-week open trial of cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or a combination of the two. Clinicians rated participants' clinical severity at five time points, and participants reported their symptoms before and after treatment. Latent growth curve models were used to predict rate of change in clinical severity from pretreatment affect in natural settings. RESULTS: Participants with high positive affect (PA), low negative affect (NA), and a high PA:NA ratio at baseline had lower severity, depressive symptoms, and anxiety symptoms at the end of treatment. Lower posttreatment symptoms were associated with spending more time with fathers and less time with peers before treatment. Although baseline affect was not associated with initial symptom severity, high NA and low PA:NA at baseline were related to slower rate of decline of severity during treatment. When baseline symptoms were included in models, NA and PA:NA predicted rate of decline in severity during treatment, whereas self-reported depressive and anxiety symptoms at baseline did not. CONCLUSION: A more typical profile of baseline affective functioning in natural settings-that is, lower NA and higher PA-and time with fathers, could provide a foundation for treatment response in children and adolescents. Affective and social dynamics in natural settings could ultimately help investigate which young people might benefit from current treatments.
目的:儿童和青少年情感障碍对治疗的反应存在差异,任何一种治疗方法改善所有患者预后的能力都有限。遗憾的是,我们对解释这种治疗反应差异的因素知之甚少。日常生活中社会和情感动态的个体差异可能有助于阐明对治疗有反应的青少年的特征。 方法:我们对患有抑郁和焦虑障碍的青少年样本进行了为期4天的自然环境中消极情绪、积极情绪和同伴的生态瞬时评估,这些青少年参加了为期8周的认知行为疗法(CBT)、选择性5-羟色胺再摄取抑制剂(SSRI)或两者联合治疗的开放试验。临床医生在五个时间点对参与者的临床严重程度进行评分,参与者报告治疗前后的症状。使用潜在生长曲线模型根据自然环境中治疗前的情绪来预测临床严重程度的变化率。 结果:在基线时具有高积极情绪(PA)、低消极情绪(NA)和高PA:NA比值的参与者在治疗结束时具有较低的严重程度、抑郁症状和焦虑症状。治疗后症状较轻与治疗前与父亲相处时间较多、与同伴相处时间较少有关。虽然基线情绪与初始症状严重程度无关,但基线时高NA和低PA:NA与治疗期间严重程度下降速度较慢有关。当将基线症状纳入模型时,NA和PA:NA可预测治疗期间严重程度的下降率,而基线时自我报告的抑郁和焦虑症状则不能。 结论:自然环境中更典型的基线情感功能特征,即较低的NA和较高的PA,以及与父亲相处的时间,可为儿童和青少年的治疗反应提供基础。自然环境中的情感和社会动态最终可能有助于研究哪些年轻人可能从当前治疗中获益。
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