Centre for Developmental Psychiatry and Psychology, School of Psychology and Psychiatry, Monash University, Notting Hill, Australia.
Aust N Z J Psychiatry. 2013 Jun;47(6):556-63. doi: 10.1177/0004867413481630. Epub 2013 Mar 18.
Sleep disturbances are highly prevalent in adolescents with depressive disorders. To date there is limited evidence of the extent to which sleep disturbances are associated with treatment response in adolescents. This study aimed to examine the extent to which self-reported sleep disturbances are associated with treatment response in adolescents with depression.
Sleep data were gathered from a sample of 166 adolescents (aged 12-18 years) with a diagnosis of a DSM-IV depressive disorder who underwent 3 months of treatment (psychosocial and/or pharmacotherapy (sertraline)) in community-based research programs. The subjective report of sleep disturbance within depressive disorders was assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children at three time points: pre-treatment, post-treatment and 6-month follow-up.
Sixty-nine percent of participants had a sleep disturbance pre-treatment and approximately 75% of these participants had threshold symptoms. Threshold sleep disturbances that persisted from pre- to post-treatment assessments were positively associated with depression at the 6-month follow-up. An ordered logistic regression model controlling for gender, treatment group and comorbid anxiety estimated a 70% risk of depression or partial remission for those with persistent sleep disturbance. Treatment group, anxiety and gender generally had no significant effect on the relationship between sleep and depression.
Sleep disturbances were highly related to depressive state and were associated with poorer treatment response in adolescents with depression. These results provide a rationale for further exploration of sleep-related treatments for adolescents with depression. Knowledge of patient-reported persistent sleep disturbances can help clinicians to predict treatment outcomes and may direct them to augment treatment or focus on sleep-related treatment strategies.
睡眠障碍在患有抑郁症的青少年中非常普遍。迄今为止，有关睡眠障碍与青少年治疗反应之间的关联程度的证据有限。本研究旨在研究睡眠障碍在多大程度上与患有抑郁症的青少年的治疗反应相关。
睡眠数据来自 166 名（年龄在 12-18 岁）被诊断为 DSM-IV 抑郁障碍的青少年样本，他们在社区为基础的研究计划中接受了 3 个月的治疗（心理社会和/或药物治疗（舍曲林））。使用儿童情感障碍和精神分裂症谱系评估量表在三个时间点评估抑郁障碍内的睡眠障碍主观报告：治疗前、治疗后和 6 个月随访。
69%的参与者在治疗前存在睡眠障碍，其中约 75%的参与者存在阈症状。从治疗前到治疗后评估持续存在的阈睡眠障碍与 6 个月随访时的抑郁相关。在控制性别、治疗组和共病焦虑的有序逻辑回归模型中，对于持续存在睡眠障碍的患者，抑郁或部分缓解的风险估计为 70%。治疗组、焦虑和性别通常对睡眠与抑郁之间的关系没有显著影响。
睡眠障碍与抑郁状态高度相关，并与青少年抑郁患者的治疗反应较差相关。这些结果为进一步探索针对青少年抑郁症的睡眠相关治疗提供了依据。了解患者报告的持续睡眠障碍可以帮助临床医生预测治疗结果，并可能指导他们增强治疗或专注于睡眠相关的治疗策略。
