Demyttenaere Koen, Desaiah Durisala, Raskin Joel, Cairns Victoria, Brecht Stephan
University Psychiatric Center KU Leuven, Campus Gasthuisberg, Leuven, Belgium (Dr Demyttenaere); Eli Lilly and Company, Indianapolis, Indiana (Dr Desaiah); Eli Lilly and Company, Toronto, Canada (Dr Raskin); Boehringer Ingelheim GmbH (consultant statistician), Oxford, United Kingdom (Dr Cairns); and Boehringer Ingelheim GmbH, Ingelheim, Germany (Dr Brecht).
Prim Care Companion CNS Disord. 2014;16(3). doi: 10.4088/PCC.13m01591. Epub 2014 May 1.
To evaluate suicidal thoughts in relationship to depressive symptom severity and reasons for living in patients hospitalized for major depressive disorder (MDD).
A post hoc analysis was conducted of a randomized, double-blind, parallel-group trial involving hospitalized patients with MDD (DSM-IV criteria) who received duloxetine 60 mg once daily or duloxetine 60 mg twice daily for 8 weeks. After 4 weeks, the dose for nonresponders receiving 60 mg once daily could be increased to 60 mg twice daily (double-blind). The study was conducted between February 9, 2007, and August 26, 2008 at 43 centers in 4 countries across Europe and South Africa. Suicidal thoughts were assessed with Montgomery-Asberg Depression Rating Scale (MADRS) item 10, depression severity was assessed with the 6-item Hamilton Depression Rating Scale and the Clinical Global Impressions-Severity of Illness scale, and protective factors were assessed with the patient-rated Reasons for Living Inventory (RFL) assessing 6 domains. Descriptive statistics, correlation, and linear regression analysis were performed.
At baseline, patients (N = 336) had varying severity of suicidal thoughts: 18% had a score ≥ 4. The proportion of patients with a score ≥ 4 decreased to 7% at week 1 and 1% at week 8 of treatment. The RFL scores at baseline were lower in patients with higher baseline suicidal thoughts and increased significantly during treatment (P < .0001). A regression model revealed that only 16% of variance in baseline total RFL score is explained by the different MADRS items. Eight patients had suicidal behavior or ideation recorded as an adverse event during the study; no consistent pattern was found in the different psychometric scores either at baseline or at the visit preceding the suicidal behavior/ideation.
Suicidality rapidly decreased in hospitalized patients with severe depression treated with duloxetine. The RFL scores were low at baseline but increased during treatment, suggesting that they are at least partially state rather than trait variables. Since RFL scores are lower in depressed inpatients, these scores lose the predictive value that they have in a general population sample.
ClinicalTrials.gov identifier: NCT00422162.
评估重度抑郁症（MDD）住院患者自杀念头与抑郁症状严重程度及生存理由之间的关系。
对一项随机、双盲、平行组试验进行事后分析，该试验纳入了符合DSM-IV标准的MDD住院患者，他们接受每日一次60毫克度洛西汀或每日两次60毫克度洛西汀治疗8周。4周后，每日一次服用60毫克无反应者的剂量可增至每日两次60毫克（双盲）。该研究于2007年2月9日至2008年8月26日在欧洲和南非4个国家的43个中心进行。采用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）第10项评估自杀念头，采用6项汉密尔顿抑郁评定量表和临床总体印象-疾病严重程度量表评估抑郁严重程度，采用患者自评的生存理由量表（RFL）评估6个领域的保护因素。进行描述性统计、相关性分析和线性回归分析。
基线时，患者（N = 336）自杀念头严重程度各异：18%的患者得分≥4分。治疗第1周时，得分≥4分的患者比例降至7%，治疗第8周时降至1%。基线时自杀念头较高的患者RFL得分较低，且治疗期间显著升高（P < .0001）。回归模型显示，不同的MADRS项目仅能解释基线总RFL得分16%的变异。8例患者在研究期间有自杀行为或意念被记录为不良事件；在基线或自杀行为/意念发生前的访视中，不同的心理测量分数均未发现一致模式。
用度洛西汀治疗的重度抑郁住院患者自杀倾向迅速降低。RFL得分在基线时较低，但治疗期间升高，表明它们至少部分是状态变量而非特质变量。由于抑郁住院患者的RFL得分较低，这些分数失去了在一般人群样本中的预测价值。
ClinicalTrials.gov标识符：NCT00422162。
