Figueroa Caroline A, Ruhé Henricus G, Koeter Maarten W, Spinhoven Philip, Van der Does Willem, Bockting Claudi L, Schene Aart H
Department of Psychiatry, Program for Mood Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Clin Psychiatry. 2015 Oct;76(10):e1306-12. doi: 10.4088/JCP.14m09268.
Major depressive disorder (MDD) is a burdensome disease that has a high risk of relapse/recurrence. Cognitive reactivity appears to be a risk factor for relapse. It remains unclear, however, whether dysfunctional cognitions alone or the reactivity of such cognitions to mild states of sadness (ie, cognitive reactivity) is the crucial factor that increases relapse risk. We aimed to assess the long-term predictive value of cognitive reactivity versus dysfunctional cognitions and other risk factors for depressive relapse.
In a prospective cohort of outpatients (N = 116; studied between 2000-2005) who had experienced ≥ 2 previous major depressive episodes (MDEs) and were in remission (DSM-IV) at the start of follow-up, we measured cognitive reactivity, with the Leiden Index of Depression Sensitivity (LEIDS), and dysfunctional cognitions, with the Dysfunctional Attitudes Scale, simultaneously. Course of illness (with the primary outcome of MDE assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders Patient Edition) and time to relapse were monitored prospectively for 3.5 years.
Cognitive reactivity scores were associated with time to relapse over the 3.5-year follow-up and also when corrected for the number of previous MDEs and concurrent depressive symptoms (hazard ratio for 1 standard deviation [(HR(SD)); 20 points of the LEIDS, measuring cognitive reactivity] = 1.47; 95% CI, 1.04-2.09; P = .031). Rumination appeared to be a particularly strong predictor of relapse (HR(SD) = 1.60; 95% CI, 1.13-2.26; P = .007). Dysfunctional cognitions did not predict relapse over 3.5 years (HR(SD) = 1.00; 95% CI, 0.74-1.37; P = .93). Every 20-point increase on the cognitive reactivity scale resulted in a 10% to 15% increase in risk of relapse (corrected for previous MDEs and concurrent depressive symptoms).
Cognitive reactivity--and particularly rumination--is a long-term predictor of relapse. Future research should address whether psychological interventions can improve cognitive reactivity scores and thereby prevent depressive relapses.
ISRCTN Identifier: 68246470.
重度抑郁症（MDD）是一种负担沉重的疾病，复发风险很高。认知反应性似乎是复发的一个危险因素。然而，尚不清楚仅是功能失调性认知，还是此类认知对轻度悲伤状态的反应性（即认知反应性）是增加复发风险的关键因素。我们旨在评估认知反应性与功能失调性认知及其他抑郁复发危险因素的长期预测价值。
在一个前瞻性队列门诊患者（N = 116；于2000 - 2005年进行研究）中，这些患者既往经历过≥2次重度抑郁发作（MDEs），且在随访开始时处于缓解期（DSM - IV标准），我们同时用莱顿抑郁敏感性指数（LEIDS）测量认知反应性，并用功能失调性态度量表测量功能失调性认知。前瞻性监测疾病进程（主要结局为通过DSM - IV轴I障碍患者版结构化临床访谈评估的MDE）和复发时间，为期3.5年。
在3.5年的随访期间，认知反应性得分与复发时间相关，在对既往MDE次数和并发抑郁症状进行校正后也是如此（1个标准差的风险比[(HR(SD))；LEIDS测量认知反应性的20分] = 1.47；95%置信区间，1.04 - 2.09；P = 0.031）。沉思似乎是复发的一个特别强的预测因素（HR(SD) = 1.60；95%置信区间，1.13 - 2.26；P = 0.007）。功能失调性认知在3.5年期间并未预测复发（HR(SD) = 1.00；95%置信区间，0.74 - 1.37；P = 0.93）。认知反应性量表上每增加20分，复发风险增加10%至15%（对既往MDE和并发抑郁症状进行校正后）。
认知反应性——尤其是沉思——是复发的长期预测因素。未来的研究应探讨心理干预是否能够改善认知反应性得分，从而预防抑郁复发。
ISRCTN标识符：68246470。
