Universitair Centrum Psychiatrie CC 30, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
Department of Psychiatry, Research School of Behavioural and Cognitive Neurosciences (BCN), Interdisciplinary Center Psychopathology of Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
J Clin Psychiatry. 2018 Jan/Feb;79(1). doi: 10.4088/JCP.17m11475.
We investigated if the degree of treatment resistance of depression, as measured by the Maudsley Staging Method (MSM), is predictive of a worse depression outcome by using a large naturalistic cohort of depressed patients.
643 subjects from the general population, primary care, and secondary care who suffered from current depressive disorder were included from the Netherlands Study of Depression and Anxiety baseline assessment. The diagnostic criterion was major depressive disorder (MDD) in the last month, based on the Composite Interview Diagnostic Instrument (CIDI), or a CIDI diagnosis of MDD in the past 6 months with an Inventory of Depressive Symptomatology Self-Report score > 24 at baseline. In these subjects, composite scores of the MSM, based on duration, severity, and treatment history of current episode, were determined retrospectively. We then determined if the MSM score prospectively predicted the 2-year course of depression after baseline. The primary outcomes were percentage of follow-up time spent in a depressive episode and being "mostly depressed" (≥ 50% of the follow-up) between baseline and 2-year follow-up.
The MSM predicted "percentage of follow-up time with depression" (P < .001) and was associated with being "mostly depressed" (OR = 1.40; 95% CI, 1.23-1.60; P < .001). These effects were not modified by having received treatment.
The current study shows that the MSM is a promising tool to predict worse depression outcomes in depressed patients. In this study that adds to previous work, we show the applicability of MSM in a wider range of primary and secondary care patients with depression.
通过对大量抑郁症患者进行自然队列研究，我们调查了使用马氏分期法（Maudsley Staging Method，MSM）衡量的抑郁症治疗抵抗程度是否对抑郁症结局更差具有预测性。
从荷兰抑郁与焦虑研究的基线评估中纳入了来自普通人群、初级保健和二级保健的 643 名患有当前抑郁障碍的患者。诊断标准为过去一个月内的主要抑郁障碍（MDD），基于复合访谈诊断工具（CIDI），或过去 6 个月内 CIDI 诊断为 MDD，同时基线时的抑郁症状自评量表自我报告得分＞24。在这些患者中，根据当前发作的持续时间、严重程度和治疗史，回顾性确定 MSM 的综合评分。然后，我们确定 MSM 评分是否能前瞻性预测基线后 2 年的抑郁病程。主要结局是抑郁发作的随访时间百分比和从基线到 2 年随访期间“大部分时间抑郁”（≥50%的随访时间）。
MSM 预测了“随访时间内抑郁的百分比”（P＜.001），并与“大部分时间抑郁”（OR=1.40；95% CI，1.23-1.60；P＜.001）相关。这些影响不受治疗的影响。
本研究表明，MSM 是预测抑郁患者更差抑郁结局的一种有前途的工具。在这项研究中，我们在更广泛的初级和二级保健抑郁症患者中进一步证明了 MSM 的适用性。
