Shrestha Srijana, Stanley Melinda A, Wilson Nancy L, Cully Jeffrey A, Kunik Mark E, Novy Diane M, Rhoades Howard M, Amspoker Amber B
VA HSR&D Houston Center for Innovations in Quality,Effectiveness and Safety,Michael E. DeBakey VA Medical Center,(MEDVAMC 152),2002 Holcombe Blvd., Houston,TX 77030,USA.
Department of Anesthesiology and Pain Medicine,The University of Texas M.D. Anderson Cancer Center,1515 Holcombe Blvd.,Unit 409,Houston,TX 77030,USA.
Int Psychogeriatr. 2015 Jul;27(7):1207-15. doi: 10.1017/S1041610214002567. Epub 2014 Dec 12.
Quality of life (QOL) is lower in older adults with generalized anxiety disorder (GAD). QOL generally improves following cognitive-behavioral treatment for GAD. Little is known, however, about additional variables predicting changes in QOL in older adults with GAD. This study examined predictors of change in QOL among older participants in a randomized clinical trial of cognitive behavioral therapy (CBT) for GAD, relative to enhanced usual care (EUC).
Hierarchical multilevel mixed-model analyses were used to examine inter-individual and intra-individual factors that predicted QOL over time. Predictors were categorized into treatment, personal and clinical characteristics.
QOL improved over time, and there was significant variability between participants in change in QOL. Controlling for treatment condition, baseline general self-efficacy, baseline social support, within-person variation in worry and depression and average levels of depression across different time points predicted changes in QOL.
QOL has increasingly been used as an outcome measure in treatment outcome studies to focus on overall improvement in functioning. Attention to improvement in symptoms of depression and worry, along with psychosocial variables, such as social support and self-efficacy, may help improve QOL in older adults with GAD. This study was a secondary study of data from a randomized clinical trial (NCT00308724) registered with clinical.trials.gov.
广泛性焦虑障碍(GAD)老年患者的生活质量(QOL)较低。GAD的认知行为治疗后QOL通常会改善。然而,关于预测GAD老年患者QOL变化的其他变量知之甚少。本研究在一项针对GAD的认知行为疗法(CBT)与强化常规护理(EUC)的随机临床试验中,考察了老年参与者QOL变化的预测因素。
采用分层多级混合模型分析来考察随时间推移预测QOL的个体间和个体内因素。预测因素分为治疗、个人和临床特征。
QOL随时间改善,且参与者之间QOL变化存在显著差异。在控制治疗条件、基线总体自我效能感、基线社会支持、个体内担忧和抑郁的变化以及不同时间点的抑郁平均水平后,这些因素可预测QOL的变化。
在治疗结果研究中,QOL越来越多地被用作一项结果指标,以关注功能的整体改善。关注抑郁和担忧症状的改善,以及心理社会变量,如社会支持和自我效能感,可能有助于改善GAD老年患者的QOL。本研究是对一项在clinical.trials.gov注册的随机临床试验(NCT00308724)数据的二次研究。