Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA.
Depress Anxiety. 2017 Dec;34(12):1123-1133. doi: 10.1002/da.22677. Epub 2017 Aug 18.
Some individuals with major depressive disorder do not experience a remission even after one or more adequate treatment trials. In some others who experience remission, it happens at variable times. This study sought to estimate the prevalence of nonremission in a large sample of patient participating in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial and to identify correlates of nonremission and time to remission among remitters.
Using data from 3,606 participants of STAR*D, the study used cure regression modeling to estimate nonremission and jointly model correlates of nonremission and time to remission among the remitters.
Overall, 14.7% of the STAR*D participants were estimated to be nonremitters. Among remitters, the rate of remission declined over time. Greater severity, poorer physical health, and poor adherence with treatments were associated with both nonremission and a longer time to remission among the remitters in multivariable analyses, whereas unemployment, not having higher education, and longer duration of current episode were uniquely associated with nonremission; whereas, treatment in specialty mental health settings, poorer mental health functioning, and greater impairment in role functioning with a longer time to remission among remitters.
Poor treatment adherence and poor physical health appear to be common risk factors for both nonremission and longer time to remission, highlighting the importance of integrated care models that address both medical and mental healthcare needs and interventions aimed at improving treatment adherence.
一些患有重度抑郁症的患者，即使经过一次或多次充分的治疗试验，也无法缓解症状。在另一些患者中，缓解的情况则发生在不同的时间。本研究旨在估计参加序列治疗选择缓解抑郁（STAR*D）试验的大量患者中未缓解的患病率，并确定缓解者未缓解和缓解时间的相关因素。
本研究使用来自 STAR*D 的 3606 名参与者的数据，采用治愈回归模型来估计未缓解者的比例，并对缓解者的未缓解和缓解时间的相关因素进行联合建模。
总体而言，STAR*D 参与者中有 14.7%被估计为未缓解者。在缓解者中，缓解率随着时间的推移而下降。在多变量分析中，更严重的病情、较差的身体健康状况和较差的治疗依从性与未缓解者的未缓解和缓解时间延长均相关，而失业、未接受高等教育和当前发作持续时间较长与未缓解者的未缓解相关；而在专科心理健康机构接受治疗、心理健康功能较差和角色功能受损程度较大则与缓解者的缓解时间延长相关。
较差的治疗依从性和较差的身体健康状况似乎是未缓解和缓解时间延长的共同危险因素，这突出了需要综合医疗模式的重要性，该模式需要同时满足医疗和心理健康需求，并需要采取干预措施来提高治疗的依从性。
