Demyttenaere Koen, Donneau Anne-Françoise, Albert Adelin, Ansseau Marc, Constant Eric, van Heeringen Kees
University Psychiatric Centre, University of Leuven, Campus Gasthuisberg, Leuven, Belgium.
Department of Medical Informatics and Biostatistics, University of Liège, CHU Sart Tilman, Liège, Belgium.
J Affect Disord. 2015 Mar 15;174:372-7. doi: 10.1016/j.jad.2014.12.002. Epub 2014 Dec 10.
The influence of discordance in what is important in being cured from depression on clinical outcome at 6 months, assessed with a divergence index.
304 outpatients treated for depression by general practitioners or by psychiatrists and completing a 6-month treatment period: a divergence index (divergence between physician and patient view on what is important in being cured from depression) was calculated for each physician-patient pair. The relation between this index and outcome at 6 months was analyzed (including depressive, anxious and somatic symptom severity, positive effect, functional impairment and quality of life (psychological and social relations).
Response rates (50% improvement) were 65.9% for depressive symptomatology and 46.2% for anxious symptomatology. The subgroup with a poor physician-patient agreement (highest quartile) on expectations had a worse clinical outcome than the subgroup with an excellent physician-patient agreement (lowest quartile): differences in response rate between these groups ranged from 9% to 27%; this difference reached statistical significance for 3 outcome variables (anxiety, positive effect and social relationships).
The study shows that outcomes with standard antidepressant drugs are still suboptimal and that discordance between what patients׳ and physicians׳ consider important in the definition of cure from depression significantly influences clinical outcomes at 6 months.
通过分歧指数评估抑郁症治愈中重要因素的不一致对6个月临床结局的影响。
304名由全科医生或精神科医生治疗抑郁症并完成6个月治疗期的门诊患者：为每对医患计算一个分歧指数（医患对抑郁症治愈中重要因素的看法之间的分歧）。分析该指数与6个月结局之间的关系（包括抑郁、焦虑和躯体症状严重程度、积极效果、功能损害和生活质量（心理和社会关系））。
抑郁症状的缓解率（改善50%）为65.9%，焦虑症状的缓解率为46.2%。在期望方面医患一致性差的亚组（最高四分位数）的临床结局比医患一致性好的亚组（最低四分位数）更差：这些组之间的缓解率差异在9%至27%之间；这种差异在3个结局变量（焦虑、积极效果和社会关系）上具有统计学意义。
该研究表明，标准抗抑郁药物的疗效仍不理想，并且患者和医生在抑郁症治愈定义中认为重要的因素之间的不一致显著影响6个月时的临床结局。
