Szigethy Eva, Youk Ada O, Gonzalez-Heydrich Joseph, Bujoreanu Simona I, Weisz John, Fairclough Diane, Ducharme Peter, Jones Neil, Lotrich Francis, Keljo David, Srinath Arvind, Bousvaros Athos, Kupfer David, DeMaso David R
*Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; †Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania; ‡Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; §Department of Psychology, Harvard University, Cambridge, Massachusetts; ‖Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado; ¶Department of Pediatric Gastroenterology, Children's Hospital of Pittsburgh UPMC, Pittsburgh, Pennsylvania; and **Department of Pediatric Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.
Inflamm Bowel Dis. 2015 Jun;21(6):1321-8. doi: 10.1097/MIB.0000000000000358.
Crohn's disease (CD) is associated with depression. It is unclear if psychosocial interventions offer benefit for depressive symptoms during active CD. In this secondary analysis of a larger study of treating depression in pediatric inflammatory bowel disease, we assessed whether cognitive behavioral therapy (CBT) would differentiate from supportive nondirective therapy in treating depression and disease activity in youth with CD. We also explored whether somatic depressive symptoms showed a different pattern of response in the overall sample and the subset with active inflammatory bowel disease.
Youth with depression and CD (n = 161) were randomized to 3 months of CBT (teaching coping skills) or supportive nondirective therapy (supportive listening). Depressive severity was measured using the Children's Depression Rating Scale-Revised (CDRS-R) with the somatic depressive subtype consisting of those CDRS-R items, which significantly correlated with CD activity. Disease activity was measured by the Pediatric Crohn's disease Activity Index. Given the potential confound of higher dose steroids, subanalyses excluded subjects on >20 mg/d prednisone equivalent (n = 34).
Total CDRS-R scores in the overall sample significantly decreased over time after both treatments (P < 0.0001). Treatment with CBT was associated with a significantly greater improvement in the Pediatric Crohn's disease Activity Index (P = 0.05) and somatic depressive subtype (P = 0.03) in those with active inflammatory bowel disease (n = 95) compared with supportive nondirective therapy. After excluding those on steroids (n = 34), there was a significant improvement in total CDRS-R (P = 0.03) and in Pediatric Crohn's disease Activity Index (P = 0.03) after CBT.
Psychotherapy may be a useful adjunct to treat depression in the context of CD-related inflammation in youth who are not concurrently on higher dose steroids.
克罗恩病（CD）与抑郁症有关。目前尚不清楚心理社会干预措施对活动期CD患者的抑郁症状是否有益。在这项对小儿炎症性肠病抑郁症治疗的大型研究的二次分析中，我们评估了认知行为疗法（CBT）在治疗CD青少年的抑郁症和疾病活动方面是否与支持性非指导性疗法有所不同。我们还探讨了躯体抑郁症状在整个样本以及患有活动性炎症性肠病的子集中是否表现出不同的反应模式。
患有抑郁症和CD的青少年（n = 161）被随机分为接受3个月的CBT（教授应对技巧）或支持性非指导性疗法（支持性倾听）。使用儿童抑郁评定量表修订版（CDRS-R）测量抑郁严重程度，躯体抑郁亚型由与CD活动显著相关的那些CDRS-R项目组成。通过小儿克罗恩病活动指数测量疾病活动度。鉴于高剂量类固醇的潜在混杂因素，亚分析排除了泼尼松等效剂量>20mg/d的受试者（n = 34）。
两种治疗后，整个样本中的CDRS-R总分随时间显著下降（P < 0.0001）。与支持性非指导性疗法相比，对于患有活动性炎症性肠病的患者（n = 95），CBT治疗在小儿克罗恩病活动指数（P = 0.05）和躯体抑郁亚型（P = 0.03）方面有显著更大的改善。排除使用类固醇的患者（n = 34）后，CBT治疗后CDRS-R总分（P = 0.03）和小儿克罗恩病活动指数（P = 0.03）有显著改善。
心理治疗可能是治疗未同时使用高剂量类固醇的青少年CD相关炎症背景下抑郁症的有用辅助手段。
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