Stiles-Shields C, Corden M E, Kwasny M J, Schueller S M, Mohr D C
Department of Preventive Medicine and Center for Behavioral Intervention Technologies,Northwestern University Feinberg School of Medicine,Chicago,IL,USA.
Psychol Med. 2015 Nov;45(15):3205-15. doi: 10.1017/S0033291715001208. Epub 2015 Jun 16.
Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression.
A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18).
The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome.
Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.
认知行为疗法（CBT）可以通过多种方式有效实施，包括电话治疗（T-CBT）和面对面治疗（FtF-CBT）。本研究的目的是探索T-CBT和FtF-CBT治疗抑郁症的疗效预测因素。
共有325名抑郁症患者被随机分配接受18次45分钟的T-CBT或FtF-CBT治疗。使用汉密尔顿抑郁量表（HAMD）和患者健康问卷-9（PHQ-9）测量抑郁严重程度。采用分类与回归树（CART）分析，以患者的基线人口统计学和心理特征预测治疗结束时（第18周）的抑郁结局，即HAMD和PHQ-9评分。
人口统计学和心理特征分别准确识别出HAMD和PHQ-9评分中85.3%和85.0%的治疗有效者以及85.7%和85.0%的治疗无效者。应对自我效能感（CSE）量表可预测HAMD和PHQ-9评分的结局；中高CSE水平者可能有疗效，且无其他变量影响该预测。在低CSE水平者中，抑郁严重程度影响疗效。社会支持、身体功能和就业仅为HAMD评分的预测因素，而性别是PHQ-9评分疗效的预测因素。治疗方式（即电话治疗或面对面治疗）不影响疗效预测。
研究结果表明，不同治疗方式下抑郁症改善的预测因素相似。最重要的是，中高水平的CSE显著增加了T-CBT和FtF-CBT治疗有效的机会。在低CSE水平的患者中，抑郁症状较轻者治疗效果更佳。
