Artherholt Samantha B, Hong Fangxin, Berry Donna L, Fann Jesse R
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Biol Blood Marrow Transplant. 2014 Jul;20(7):946-50. doi: 10.1016/j.bbmt.2014.03.010. Epub 2014 Mar 18.
Despite the prevalence and known adverse impacts of depression after hematopoietic cell transplantation (HCT), little is known about the trajectory of depression occurring after HCT, or which pretransplantation risk factors might help predict new or worsening post-HCT depression. This secondary analysis evaluated the relationships between pre-HCT patient-reported outcomes and demographic characteristics and post-HCT depression. A total of 228 adult HCT patients were evaluated pre-HCT (T1) and again at 6 to 7 weeks post-HCT (T2), using touch-screen computers in the transplantation clinic during participation in a larger trial. Measures evaluated included the Symptom Distress Scale, the EORTC QLQ-C30 for quality of life, a single-item pain intensity question, and the Patient Health Questionnaire 9 for measurement of depression. At T1, rates of depression were quite low, with only 6% of participants reporting moderate or higher depression. At T2, however, the prevalence of moderate or higher depression was 31%. We observed a strong linear relationship in PHQ-9 scores between T1 and T2 (P < .0001). Depression score at T1 was a significant predictor of depression score at T2 (P = .03), as was poorer emotional function at T1 (P < .01). Our results indicate that post-HCT depression is common, even in patients with a low pre-HCT depression score. Frequent screening for symptoms of depression at critical time points, including 6 to 7 weeks post-HCT, are needed in this population, followed by referrals to supportive care as appropriate.
尽管造血细胞移植（HCT）后抑郁症普遍存在且已知具有不良影响，但对于HCT后发生抑郁症的轨迹，或者哪些移植前风险因素可能有助于预测HCT后新出现的或加重的抑郁症，人们了解甚少。这项二次分析评估了移植前患者报告的结局和人口统计学特征与HCT后抑郁症之间的关系。共有228名成年HCT患者在移植前（T1）接受评估，并在HCT后6至7周（T2）再次接受评估，在参与一项更大规模试验期间，于移植诊所使用触摸屏电脑进行评估。评估的指标包括症状困扰量表、用于评估生活质量的欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）、一个单项疼痛强度问题以及用于测量抑郁症的患者健康问卷9（Patient Health Questionnaire 9）。在T1时，抑郁症发生率相当低，只有6%的参与者报告有中度或更严重的抑郁症。然而，在T2时，中度或更严重抑郁症的患病率为31%。我们观察到T1和T2之间的PHQ-9评分呈强线性关系（P < .0001）。T1时的抑郁评分是T2时抑郁评分的显著预测因素（P = .03），T1时较差的情绪功能也是如此（P < .01）。我们的结果表明，即使是移植前抑郁评分较低的患者，HCT后抑郁症也很常见。在这一人群中，需要在关键时间点，包括HCT后6至7周，频繁筛查抑郁症症状，随后根据情况转诊至支持性护理。
