Weiss Jeffrey J, Prieto Sarah, Bräu Norbert, Dieterich Douglas T, Marcus Sue M, Stivala Alicia, Gorman Jack M
1 Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
2 James J. Peters Veterans Affairs Medical Center, Infectious Diseases Section, Bronx, USA.
Int J Psychiatry Med. 2018 Jul;53(4):256-272. doi: 10.1177/0091217417749796. Epub 2018 Jan 3.
Objective The primary study objective is to determine which measures of depression are associated with early discontinuation of hepatitis C virus infection treatment and to determine which measure best characterizes the depression that develops during treatment. Methods Seventy-eight treatment-naïve subjects who initiated pegylated interferon/ribavirin treatment for hepatitis C virus infection were included. Baseline depression was assessed with the Structured Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the Hamilton Depression Rating Scale, and the Beck Depression Inventory-II. The latter two measures were repeated at treatment weeks 12 and 24. Results Depression scores, as measured by the three instruments, lacked adequate consistency. Baseline depression as measured by the Beck Depression Inventory-II, but not by the other scales, was associated with early treatment discontinuation at weeks 12 and 24. Changes in depression during treatment were restricted to somatic symptoms. Of those who completed treatment, those who were not depressed at baseline tended to demonstrate significant depression increases during treatment. Conclusion The Beck Depression Inventory-II is recommended to assess depression prior to hepatitis C virus infection treatment. Somatic symptoms of depression should be monitored during treatment. Baseline depression as measured by the Beck Depression Inventory-II was associated with early treatment discontinuation. The Beck Depression Inventory-II, Structured Interview for DSM-IV, and Hamilton Depression Rating Scale yielded results that were not consistent with each other in this sample. Future research should focus on standardizing depression assessment in medically ill populations to identify measures that predict treatment discontinuation.
目的 主要研究目的是确定哪些抑郁指标与丙型肝炎病毒感染治疗的早期停药相关，并确定哪种指标最能表征治疗期间出现的抑郁。方法 纳入78名开始接受聚乙二醇化干扰素/利巴韦林治疗丙型肝炎病毒感染的初治患者。使用《精神障碍诊断与统计手册》第4版（DSM-IV）结构化访谈、汉密尔顿抑郁量表和贝克抑郁量表第二版评估基线抑郁情况。后两项指标在治疗第12周和第24周重复测量。结果 三种工具测量的抑郁评分缺乏足够的一致性。贝克抑郁量表第二版测量的基线抑郁，但其他量表未显示，与第12周和第24周的早期治疗停药相关。治疗期间抑郁的变化仅限于躯体症状。在完成治疗的患者中，基线时未抑郁的患者在治疗期间抑郁倾向于显著增加。结论 推荐使用贝克抑郁量表第二版在丙型肝炎病毒感染治疗前评估抑郁。治疗期间应监测抑郁的躯体症状。贝克抑郁量表第二版测量的基线抑郁与早期治疗停药相关。在该样本中，贝克抑郁量表第二版、DSM-IV结构化访谈和汉密尔顿抑郁量表得出的结果彼此不一致。未来研究应专注于规范患病群体的抑郁评估，以确定预测治疗停药的指标。
