van der Zanden R, Galindo-Garre F, Curie K, Kramer J, Cuijpers P
Centre for Youth Mental Health Studies, Trimbos Institute, Utrecht, The Netherlands.
EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
Psychol Med. 2014 Apr;44(6):1159-70. doi: 10.1017/S003329171300175X. Epub 2013 Jul 18.
This study investigates possible circularity in mechanisms of change in participants of Master Your Mood (MYM), a cognitive-based, online intervention for young adults with depressive symptoms. A previous study showed that MYM effectively reduced depression and anxiety and strengthened mastery.
We randomized 244 participants with depressive symptoms into MYM or a wait-list control condition. We explored the circularity hypothesis by several analyses. Correlations were computed to determine the association between (change in) depression and anxiety. Path analysis mediation models were used to explore whether change in anxiety and mastery mediated the intervention effect on depression, whether depression and mastery mediated the effect on anxiety and whether depression and anxiety mediated the effect on mastery. We used linear regression to explore whether early changes in anxiety predicted later changes in depression, and whether early changes in depression predicted later changes in anxiety.
Co-morbidity between depression and anxiety was high (69.2%) and the association between depression and anxiety change was strong (r = 0.677, p < 0.01). Changes in anxiety and mastery mediated change in depression (mediation proportion 44%); changes in depression mediated change in anxiety (79%) and mastery (75%). We did not find an early change in anxiety predictive for a late change in depression, and vice versa.
This study appears to confirm the hypothesized circularity in the recovery process. We found high co-morbidity and strong correlation between depression and anxiety levels and bi-directional relationships between potential mediators and outcomes. Early anxiety change scores were not predictive of late depression change scores, and vice versa.
本研究调查了“掌控你的情绪”（MYM）项目参与者的改变机制中可能存在的循环性，该项目是一项针对有抑郁症状的年轻人的基于认知的在线干预措施。先前的一项研究表明，MYM能有效减轻抑郁和焦虑，并增强掌控感。
我们将244名有抑郁症状的参与者随机分为MYM组或等待列表对照组。我们通过多种分析方法探讨了循环性假设。计算相关性以确定抑郁和焦虑（的变化）之间的关联。使用路径分析中介模型来探究焦虑和掌控感的变化是否介导了干预对抑郁的影响、抑郁和掌控感是否介导了对焦虑的影响，以及抑郁和焦虑是否介导了对掌控感的影响。我们使用线性回归来探究焦虑的早期变化是否能预测抑郁的后期变化，以及抑郁的早期变化是否能预测焦虑的后期变化。
抑郁和焦虑的共病率很高（69.2%），抑郁和焦虑变化之间的关联很强（r = 0.677，p < 0.01）。焦虑和掌控感的变化介导了抑郁的变化（中介比例为44%）；抑郁的变化介导了焦虑的变化（79%）和掌控感的变化（75%）。我们没有发现焦虑的早期变化能预测抑郁的后期变化，反之亦然。
本研究似乎证实了恢复过程中假设的循环性。我们发现抑郁和焦虑水平之间存在高共病率和强相关性，以及潜在中介因素和结果之间的双向关系。早期焦虑变化得分不能预测后期抑郁变化得分，反之亦然。
