Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
JAMA Psychiatry. 2013 Mar;70(3):343-50. doi: 10.1001/jamapsychiatry.2013.286.
The National Institute of Mental Health Affective Disorders Workgroup identified the assessment of an individual's burden of illness as an important need. The Individual Burden of Illness Index for Depression (IBI-D) metric was developed to meet this need.
To assess the use of the IBI-D for multidimensional assessment of treatment efficacy for depressed patients.
DESIGN, SETTING, AND PATIENTS: Complete data on depressive symptom severity, functioning, and quality of life (QOL) from depressed patients (N = 2280) at entry and exit of level 1 of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (12-week citalopram treatment) were used as the basis for calculating IBI-D and self-rating scale changes.
Principal component analysis of patient responses at the end of level 1 of STAR*D yielded a single principal component, IBI-D, with a nearly identical eigenvector to that previously reported. While changes in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report) accounted for only 50% of the variance in changes in QOL (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form) and 47% of the variance in changes in functioning (Work and Social Adjustment Scale), changes in IBI-D captured 83% of the variance in changes in QOL and 80% in functioning, while also capturing 79% of the variance in change in symptom severity (Quick Inventory of Depressive Symptomatology-Self Report). Most importantly, the changes in IBI-D of the 36.6% of remitters who had abnormal QOL and/or functioning (mean [SD], 2.98 [0.35]) were significantly less than the changes in IBI-D of those who reported normal QOL and functioning (IBI-D = 1.97; t = 32.6; P < 10(-8)) with an effect size of a Cohen d of 2.58. In contrast, differences in symptom severity, while significant, had a Cohen d of only 0.78.
Remission in depressed patients, as defined by a reduction in symptom severity, does not denote normal QOL or functioning. By incorporating multidimensional patient-reported outcomes, the IBI-D provides a single measure that adequately captures the full burden of illness in depression both prior to and following treatment; therefore, it offers a more accurate metric of recovery.
clinicaltrials.gov Identifier: NCT00021528.
国家心理健康研究所情感障碍工作组确定评估个体疾病负担是一项重要需求。个体疾病负担抑郁指数（IBI-D）指标的开发是为了满足这一需求。
评估 IBI-D 用于多维评估抑郁患者的治疗效果。
设计、地点和患者：使用来自抑郁患者（N=2280）的完整数据，这些患者在 STAR*D 研究（12 周西酞普兰治疗）的第 1 级进入和退出时进行了抑郁症状严重程度、功能和生活质量（QOL）的评估，作为计算 IBI-D 和自评量表变化的基础。
STAR*D 第 1 级结束时患者反应的主成分分析得出了一个单一的主成分，即 IBI-D，其特征向量与之前报道的几乎相同。虽然症状严重程度的变化（抑郁自评快速清单）仅占 QOL（生活质量享受和满意度问卷-简短形式）变化的 50%和功能变化的 47%（工作和社会调整量表），但 IBI-D 的变化捕捉到了 QOL 变化的 83%和功能变化的 80%，同时也捕捉到了症状严重程度变化的 79%（抑郁自评快速清单）。最重要的是，36.6%的缓解者（QOL 和/或功能异常）的 IBI-D 变化（平均值[标准差]，2.98[0.35]）明显小于那些报告 QOL 和功能正常的缓解者的 IBI-D 变化（IBI-D=1.97；t=32.6；P<10(-8)），效应量为 Cohen d 为 2.58。相比之下，症状严重程度的差异虽然显著，但 Cohen d 仅为 0.78。
抑郁患者的缓解，如症状严重程度的降低所定义的，并不表示正常的 QOL 或功能。通过纳入多维患者报告的结果，IBI-D 提供了一个单一的衡量标准，能够充分捕捉治疗前后抑郁的全部疾病负担；因此，它提供了一种更准确的恢复衡量标准。
clinicaltrials.gov 标识符：NCT00021528。
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