Fournier Jay C, DeRubeis Robert J, Amsterdam Jay, Shelton Richard C, Hollon Steven D
Jay C. Fournier, PhD, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania; Jay Amsterdam, MD, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Richard C. Shelton, MD, Department of Psychiatry and Behavioral Neurobiology, The University of Alabama at Birmingham, Birmingham, Alabama; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA.
Br J Psychiatry. 2015 Apr;206(4):332-8. doi: 10.1192/bjp.bp.113.133694. Epub 2014 Jun 12.
Depression can adversely affect employment status.
To examine whether there is a relative advantage of cognitive therapy or antidepressant medication in improving employment status following treatment, using data from a previously reported trial.
Random assignment to cognitive therapy (n = 48) or the selective serotonin reuptake inhibitor paroxetine (n = 93) for 4 months; treatment responders were followed for up to 24 months. Differential effects of treatment on employment status were examined.
At the end of 28 months, cognitive therapy led to higher rates of full-time employment (88.9%) than did antidepressant medication among treatment responders (70.8%), χ(2) 1 = 5.78, P = 0.02, odds ratio (OR) = 5.66, 95% CI 1.16-27.69. In the shorter-term, the main effect of treatment on employment status was not significant following acute treatment (χ(2) 1 = 1.74, P = 0.19, OR = 1.77, 95% CI 0.75-4.17); however, we observed a site×treatment interaction (χ(2) 1 = 6.87, P = 0.009) whereby cognitive therapy led to a higher rate of full-time employment at one site but not at the other.
Cognitive therapy may produce greater improvements in employment v. medication, particularly over the longer term.
抑郁症会对就业状况产生不利影响。
利用先前一项报告试验的数据，研究认知疗法或抗抑郁药物在治疗后改善就业状况方面是否具有相对优势。
随机分配至认知疗法组（n = 48）或选择性5-羟色胺再摄取抑制剂帕罗西汀组（n = 93），治疗4个月；对治疗有反应者随访长达24个月。研究治疗对就业状况的不同影响。
在28个月结束时，在治疗有反应者中，认知疗法导致的全职就业率（88.9%）高于抗抑郁药物治疗组（70.8%），χ(2)1 = 5.78，P = 0.02，优势比（OR）= 5.66，95%可信区间1.16 - 27.69。在短期内，急性治疗后治疗对就业状况的主要影响不显著（χ(2)1 = 1.74，P = 0.19，OR = 1.77，95%可信区间0.75 - 4.17）；然而，我们观察到一个地点×治疗交互作用（χ(2)1 = 6.87，P = 0.009），即认知疗法在一个地点导致更高的全职就业率，而在另一个地点则不然。
与药物治疗相比，认知疗法可能在就业方面产生更大改善，尤其是从长期来看。
