Lin Ching-Hua, Chou Li-Shiu, Chen Ming-Chao, Chen Cheng-Chung
Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd., Ling-Ya District, Kaohsiung 802, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, 130, Kai-Syuan 2nd Rd., Ling-Ya District, Kaohsiung 802, Taiwan.
J Affect Disord. 2015 Aug 15;182:115-20. doi: 10.1016/j.jad.2015.04.022. Epub 2015 Apr 22.
The purpose of this study was to compare the rate of symptom relief to functional improvement and examine the relationships between symptom relief and functional improvement during the acute phase of treatment.
A total of 131 acutely ill inpatients with major depressive disorder were enrolled to receive 20mg of fluoxetine daily for 6 weeks. Symptom severity, using the 17-item Hamilton Depression Rating Scale (HAMD-17), and functioning, using the Modified Work and Social Adjustment Scale (MWSAS), were measured regularly. The outcome measures were the HAMD-17 score and MWSAS score at weeks 1, 2, 3, 4, and 6. We compared the effect size and the reduction rate of HAMD-17 to those of MWSAS at week 1, 2, 3, 4, and 6. Structural equation modeling was used to examine relationships among the study variables.
Of the 131 participants, 126 had at least one post-baseline assessment at week 1 and were included in the analysis. The HAMD-17 had a larger effect size and reduction rate than the MWSAS at weeks 1, 2, 3, 4, and 6. Parsimonious model satisfied all indices of goodness-of-fit (Chi-Square/df=1.479, TLI=0.978, CFI=0.986, RMSEA=0.062) and had all paths with significant path coefficients. MWSAS at week 0 predicted HAMD-17 at week 1.
This was an open-labeled study with small sample size.
Depressive symptoms improved more quickly than functioning during the acute phase of treatment. Depressive symptoms and functional impairment are distinct domains, and should be assessed independently.
本研究旨在比较症状缓解率与功能改善情况，并探讨治疗急性期症状缓解与功能改善之间的关系。
共招募131例重度抑郁症急性病住院患者，每日服用20mg氟西汀，持续6周。定期使用17项汉密尔顿抑郁量表（HAMD-17）测量症状严重程度，使用改良工作与社会适应量表（MWSAS）测量功能状况。观察指标为第1、2、3、4和6周时的HAMD-17评分和MWSAS评分。我们比较了第1、2、3、4和6周时HAMD-17与MWSAS的效应量和降低率。采用结构方程模型检验研究变量之间的关系。
131名参与者中，126人在第1周至少有一次基线后评估，并纳入分析。在第1、2、3、4和6周时，HAMD-17的效应量和降低率均大于MWSAS。简约模型满足所有拟合优度指标（卡方/自由度=1.479，TLI=0.978，CFI=0.986，RMSEA=0.062），且所有路径的路径系数均显著。第0周的MWSAS可预测第1周的HAMD-17。
这是一项小样本的开放标签研究。
在治疗急性期，抑郁症状的改善比功能状况更快。抑郁症状和功能损害是不同的领域，应独立评估。
