Southern Health NHS Foundation Trust, Becton Centre, Barton-on-Sea, Hampshire BH25 7AE, United Kingdom.
Primary Care & Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton SO16 5ST, United Kingdom.
J Affect Disord. 2015 Mar 15;174:665-71. doi: 10.1016/j.jad.2014.12.005. Epub 2014 Dec 11.
Depressive disorders are prevalent and costly but there is a lack of evidence on how best to select treatments for mild to moderate depression in primary care. Illness beliefs have been shown to affect the outcome from physical illness, but there is limited information on the beliefs of patients who are depressed.
To measure patients׳ beliefs about depression at baseline and determine whether these relate to depression severity at six months.
Primary care patients with a recently diagnosed episode of depression completed the Beliefs about Depression Questionnaire and depression severity scores at baseline. The primary outcome was the change in depression severity score on the Hospital Anxiety and Depression Scale after six months.
227/292 (78%) participants completed follow-up questionnaires. Initial severity of depression at baseline, and particular beliefs about the causes, consequences and timeline of depression predicted poorer outcomes, whereas a belief in using exercise or keeping busy to treat depression predicted improved outcomes. Prescription of antidepressants did not appear to mediate these relationships.
This was an initial study using a new validated questionnaire and it cannot be predicted whether these results are representative or would be reproduced in other populations. Although participants were primary care patients whose GP (General Practitioner) had coded as having a new incident episode of depression in the preceding six months, 43% of participants stated they had been depressed for more than a year. Sufficient participants were recruited to ensure the study was adequately powered but participation rate was 30%, raising the possibility of response bias.
Illness beliefs may help to predict outcomes in depression and therefore assessing and addressing patients׳ beliefs about their depression may enhance treatment.
抑郁障碍普遍存在且代价高昂，但在初级保健中如何为轻度至中度抑郁选择最佳治疗方法方面，证据有限。疾病信念已被证明会影响躯体疾病的结局，但关于抑郁患者信念的信息有限。
测量患者在基线时对抑郁的信念，并确定这些信念是否与六个月时的抑郁严重程度有关。
最近被诊断为抑郁发作的初级保健患者在基线时完成了抑郁信念问卷和抑郁严重程度评分。主要结局是六个月后汉密尔顿焦虑和抑郁量表（HADS）上抑郁严重程度评分的变化。
227/292（78%）名参与者完成了随访问卷。基线时的初始抑郁严重程度，以及对抑郁的原因、后果和时间进程的特定信念，预测了较差的结局，而相信用运动或保持忙碌来治疗抑郁则预测了较好的结局。抗抑郁药的处方似乎并没有调节这些关系。
这是一项使用新的验证问卷的初步研究，无法预测这些结果是否具有代表性，或者是否会在其他人群中重现。尽管参与者是初级保健患者，他们的全科医生（GP）在前六个月中编码为患有新的发作性抑郁，但 43%的参与者表示他们已经抑郁超过一年。招募了足够的参与者以确保研究具有足够的效力，但参与率为 30%，这增加了应答偏倚的可能性。
疾病信念可能有助于预测抑郁的结局，因此评估和处理患者对其抑郁的信念可能会增强治疗效果。
