Jha Manish K, Minhajuddin Abu, Greer Tracy L, Carmody Thomas, Rush Augustus John, Trivedi Madhukar H
Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, United States of America.
Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, United States of America.
PLoS One. 2016 Dec 28;11(12):e0167901. doi: 10.1371/journal.pone.0167901. eCollection 2016.
The goal of this study was to evaluate the relationship between early change in psychosocial function independent of depression severity and longer-term symptomatic remission. Participants of Combining Medications to Enhance Depression Outcomes trial were randomly selected for model selection (n = 334) and validation (n = 331). Changes in psychosocial function (Work and Social Adjustment Scale, WSAS) from baseline to week 6 were assessed and two data-driven sub-groups of WSAS change were identified in the randomly selected model selection half. Results of analyses to predict symptomatic remission at 3 and 7 months were validated for these sub-groups in the second half (validation sample). From baseline to week 6, psychosocial function improved significantly even after adjusting for depression severity at each visit and select baseline variables (age, gender, race, ethnicity, education, income, employment, depression onset before age 18, anxious features, and suicidal ideation), treatment-arm, and WSAS score. The WSAS change patterns identified two (early improvement and gradual change) subgroups. After adjusting for baseline variables and remission status at week 6, participants with early improvement in the second half (validation sample) had greater remission rates than those with gradual change at both 3 (3.3 times) and 7 months (2.3 times) following acute treatment initiation. In conclusion, early improvement in psychosocial function provides a clinically meaningful prediction of longer-term symptomatic remission, independent of depression symptom severity.
本研究的目的是评估独立于抑郁严重程度的心理社会功能早期变化与长期症状缓解之间的关系。“联合用药增强抑郁疗效”试验的参与者被随机选取用于模型选择（n = 334）和验证（n = 331）。评估从基线到第6周心理社会功能的变化（工作和社会适应量表，WSAS），并在随机选取的模型选择组中确定了两个由数据驱动的WSAS变化亚组。对预测3个月和7个月时症状缓解情况的分析结果在另一半（验证样本）的这些亚组中进行了验证。从基线到第6周，即使在对每次访视时的抑郁严重程度以及选定的基线变量（年龄、性别、种族、民族、教育程度、收入、就业情况、18岁前抑郁发作、焦虑特征和自杀意念）、治疗组和WSAS评分进行调整后，心理社会功能仍有显著改善。WSAS变化模式确定了两个亚组（早期改善组和逐渐变化组）。在对基线变量和第6周的缓解状态进行调整后，后半部分（验证样本）中早期改善的参与者在急性治疗开始后的3个月（3.3倍）和7个月（2.3倍）时的缓解率均高于逐渐变化的参与者。总之，心理社会功能的早期改善提供了对长期症状缓解的具有临床意义的预测，且独立于抑郁症状的严重程度。
