Silverstein Michael, Kistin Caroline, Bair-Merritt Megan, Wiltsey-Stirman Shannon, Feinberg Emily, Diaz-Linhart Yaminette, Sandler Jenna, Chen Ning, Cabral Howard
Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA.
Department of Pediatrics, Boston Medical Center, Vose Hall 3, One Boston Medical Center Place, Boston, MA, 02118, USA.
Arch Womens Ment Health. 2016 Feb;19(1):63-70. doi: 10.1007/s00737-015-0521-4. Epub 2015 Apr 2.
The impact of depression interventions is often attenuated in women who have experienced trauma. We explored whether psychological avoidance could explain this phenomenon. We synthesized two pilot randomized trials of problem-solving education (PSE) among a total of 93 urban mothers. Outcomes included depressive symptoms and perceived stress. Mothers with avoidant coping styles experienced an average 1.25 episodes of moderately severe depressive symptoms over 3 months of follow-up, compared to 0.40 episodes among those with non-avoidant coping (adjusted incident rate ratio [aIRR] 2.18; 95 % CI 1.06, 4.48). PSE tended to perform better among mothers with non-avoidant coping. Among mothers with non-avoidant coping, PSE mothers experienced an average 0.24 episodes, compared to 0.58 episodes among non-avoidant controls (aIRR 0.27; 95 % CI 0.05, 1.34). Among mothers with avoidant coping, PSE mothers experienced an average 1.26 episodes, compared to 1.20 episodes among avoidant controls (aIRR 0.76; 95 % CI 0.44, 1.33). This trend toward differential impact persisted when avoidance was measured as a problem-solving style and among traumatized mothers with and without avoidant PTSD symptoms. Further research is warranted to explore the hypothesis that psychological avoidance could explain why certain depression treatment and prevention strategies break down in the presence of trauma.
抑郁症干预措施的效果在经历过创伤的女性中往往会减弱。我们探讨了心理回避是否可以解释这一现象。我们综合了两项针对93名城市母亲的解决问题教育（PSE）的初步随机试验。结果包括抑郁症状和感知压力。在3个月的随访中，采用回避应对方式的母亲平均经历了1.25次中度严重抑郁症状发作，而采用非回避应对方式的母亲为0.40次（调整后的发病率比[aIRR]为2.18；95%可信区间为1.06，4.48）。PSE在采用非回避应对方式的母亲中往往效果更好。在采用非回避应对方式的母亲中，接受PSE的母亲平均经历了0.24次发作，而非回避对照组为0.58次（aIRR为0.27；95%可信区间为0.05，1.34）。在采用回避应对方式的母亲中，接受PSE的母亲平均经历了1.26次发作，而回避对照组为1.20次（aIRR为0.76；95%可信区间为0.44，1.33）。当将回避作为一种解决问题的方式进行测量时，以及在有和没有回避型创伤后应激障碍症状的受创伤母亲中，这种差异影响的趋势依然存在。有必要进行进一步的研究，以探讨心理回避是否可以解释为什么某些抑郁症治疗和预防策略在创伤存在的情况下会失效这一假设。
