Herrmann-Lingen Christoph, Beutel Manfred E, Bosbach Alexandra, Deter Hans-Christian, Fritzsche Kurt, Hellmich Martin, Jordan Jochen, Jünger Jana, Ladwig Karl-Heinz, Michal Matthias, Petrowski Katja, Pieske Burkert, Ronel Joram, Söllner Wolfgang, Stöhr Andreas, Weber Cora, de Zwaan Martina, Albus Christian
From the Department of Psychosomatic Medicine and Psychotherapy (Herrmann-Lingen, Bosbach), University of Göttingen Medical Center and German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany; Department of Psychosomatic Medicine and Psychotherapy (Beutel, Michal), University Medical Center Mainz, Mainz, Germany; Department of Psychosomatics and Psychotherapy (Deter, Weber), Charité Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany; Department of Psychosomatic Medicine and Psychotherapy (Fritzsche), University Medical Center Freiburg, Freiburg, Germany; Institute of Medical Statistics (Hellmich), Informatics and Epidemiology, University of Cologne, Köln, Germany; Clinic of Psychocardiology (Jordan), Kerckhoff Rehabilitation Center, Bad Nauheim, Germany; Department of General Internal and Psychosomatic Medicine (Jünger), University of Heidelberg, Heidelberg, Germany; Institute of Epidemiology (Ladwig), Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleißheim, Germany; Department of Psychotherapy and Psychosomatics (Petrowski), Technical University of Dresden, Dresden, Germany; Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Internal Medicine and Cardiology, German Heart Cente, and German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany (Pieske); Department of Psychosomatic Medicine and Psychotherapy (Ronel), University Hospital Rechts der Isar, Technische Universitaet Muenchen, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy (Söllner), Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany; Clinical Trials Center (Stöhr), University of Cologne, Köln, Germany; Department of Psychosomatic Medicine and Psychotherapy (de Zwaan), Hannover Medical School, Hannover, Germany; and Department of Psychosomatics and Psychotherapy (Albus),
Psychosom Med. 2016 Jul-Aug;78(6):704-15. doi: 10.1097/PSY.0000000000000332.
BACKGROUND: Depression predicts adverse prognosis in patients with coronary artery disease (CAD), but previous treatment trials yielded mixed results. We tested the hypothesis that stepwise psychotherapy improves depressive symptoms more than simple information. METHODS: In a multicenter trial, we randomized 570 CAD patients scoring higher than 7 on the Hospital Anxiety and Depression Scale-depression subscale to usual care plus either one information session (UC-IS) or stepwise psychotherapy (UC-PT). UC-PT patients received three individual psychotherapy sessions. Those still depressed were offered group psychotherapy (25 sessions). The primary outcome was changed in the Hospital Anxiety and Depression Scale-depression scores from baseline to 18 months. Preplanned subgroup analyses examined whether treatment responses differed by patients' sex and personality factors (Type D). RESULTS: The mean (standard deviation) depression scores declined from 10.4 (2.5) to 8.7 (4.1) at 18 months in UC-PT and from 10.4 (2.5) to 8.9 (3.9) in UC-IS (both p < .001). There was no significant group difference in change of depressive symptoms (group-by-time effect, p = .90). Preplanned subgroup analyses revealed no differences in treatment effects between men versus women (ptreatment-by-sex interaction = .799) but a significant treatment-by-Type D interaction on change in depressive symptoms (p = .026) with a trend for stronger improvement with UC-PT than UC-IS in Type D patients (n = 341, p = .057) and no such difference in improvement in patients without Type D (n = 227, p = .54). CONCLUSIONS: Stepwise psychotherapy failed to improve depressive symptoms in CAD patients more than UC-IS. The intervention might be beneficial for depressed CAD patients with Type D personality. However, this finding requires further study. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00705965; www.isrctn.com ISRCTN76240576.
背景：抑郁症预示着冠状动脉疾病（CAD）患者的不良预后，但先前的治疗试验结果不一。我们检验了逐步心理治疗比简单信息提供能更有效改善抑郁症状这一假设。 方法：在一项多中心试验中，我们将570名在医院焦虑抑郁量表抑郁分量表上得分高于7分的CAD患者随机分为常规护理加一次信息提供（UC - IS）组或逐步心理治疗（UC - PT）组。UC - PT组患者接受三次个体心理治疗。仍有抑郁症状的患者接受团体心理治疗（25次）。主要结局是医院焦虑抑郁量表抑郁得分从基线到18个月的变化。预先计划的亚组分析考察了治疗反应是否因患者性别和人格因素（D型人格）而异。 结果：UC - PT组患者的平均（标准差）抑郁得分在18个月时从10.4（2.5）降至8.7（4.1），UC - IS组从10.4（2.5）降至8.9（3.9）（均p <.001）。抑郁症状变化的组间差异无统计学意义（组×时间效应，p =.90）。预先计划的亚组分析显示，男性与女性之间的治疗效果无差异（治疗×性别交互作用p =.799），但在抑郁症状变化方面存在显著的治疗×D型人格交互作用（p =.026），D型人格患者（n = 341）中UC - PT组比UC - IS组改善趋势更强（p =.057），非D型人格患者（n = 227）中改善情况无差异（p =.54）。 结论：逐步心理治疗在改善CAD患者抑郁症状方面并不比UC - IS更有效。该干预措施可能对D型人格的抑郁CAD患者有益。然而，这一发现需要进一步研究。 试验注册：www.clinicaltrials.gov NCT00705965；www.isrctn.com ISRCTN76240576 。
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