McLean Carmen P, Su Yi-Jen, Carpenter Joseph K, Foa Edna B
a Department of Psychiatry , University of Pennsylvania.
b Graduate Institute of Behavioral Sciences , Chang Gung University.
J Clin Child Adolesc Psychol. 2017 Jul-Aug;46(4):500-510. doi: 10.1080/15374416.2015.1012722. Epub 2015 Mar 9.
Depressive symptoms are common among individuals with posttraumatic stress disorder (PTSD). Prolonged exposure therapy (PE) for PTSD has been found to alleviate both PTSD and depressive symptoms, but relatively little is known about the pattern of PTSD and depressive symptom change during treatment. This study aimed to investigate the relationship between changes in PTSD and depression during PE for adolescent (PE-A) and client-centered therapy (CCT). The moderating role of PE-A versus CCT and the possible differences across symptom clusters of PTSD were also examined. Participants were 61 female adolescents with sexual-assault-related PTSD randomized to PE-A (n = 31) or CCT (n = 30). Participants completed the Beck Depression Inventory and the Child PTSD Symptom Scale at pre-, mid-, and posttreatment and before each treatment session. Multilevel mediation analysis indicated a reciprocal but asymmetrical relationship between changes in PTSD and depression during treatment in the overall sample. Moderated mediation analysis showed that the reciprocal relation was observed only during PE-A. Reductions in PTSD led to reductions in depression to a greater extent (48.7%), 95% confidence interval [30.2, 67.2], than vice versa (22.0%), [10.6, 33.4]. For participants receiving CCT, reduction in PTSD led to reductions in depression (31.6%), [11.8, 51.4], but not vice versa (7.4%), [-7.1, 21.9]. The reciprocal relationship between PTSD and depression was also observed across different symptoms clusters of PTSD. Our findings suggest that changes in PTSD led to changes in depressive symptoms to a greater extent than vice versa across PE-A and CCT.
创伤后应激障碍（PTSD）患者中抑郁症状很常见。已发现针对PTSD的延长暴露疗法（PE）可减轻PTSD和抑郁症状，但对于治疗期间PTSD和抑郁症状变化的模式了解相对较少。本研究旨在调查青少年延长暴露疗法（PE-A）和以客户为中心疗法（CCT）治疗期间PTSD变化与抑郁之间的关系。还研究了PE-A与CCT的调节作用以及PTSD不同症状群之间可能存在的差异。参与者为61名与性侵犯相关的PTSD女性青少年，随机分为PE-A组（n = 31）或CCT组（n = 30）。参与者在治疗前、治疗中期、治疗后以及每次治疗 session 前完成贝克抑郁量表和儿童PTSD症状量表。多层次中介分析表明，总体样本治疗期间PTSD变化与抑郁之间存在相互但不对称的关系。调节中介分析表明，仅在PE-A期间观察到这种相互关系。PTSD的减轻导致抑郁减轻的程度更大（48.7%），95%置信区间[30.2, 67.2]，而反之则不然（22.0%），[10.6, 33.4]。对于接受CCT的参与者，PTSD的减轻导致抑郁减轻（31.6%），[11.8, 51.4]，但反之则不然（7.4%），[-7.1, 21.9]。在PTSD的不同症状群中也观察到了PTSD与抑郁之间的相互关系。我们的研究结果表明，在PE-A和CCT中，PTSD的变化比抑郁症状的变化导致抑郁症状变化的程度更大。
