治疗抑郁症伴发的失眠：失眠相关因素预测长期抑郁轨迹。
Treating insomnia in depression: Insomnia related factors predict long-term depression trajectories.
机构信息
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University.
Department of Psychiatry and Behavioral Sciences, Stanford University.
出版信息
J Consult Clin Psychol. 2018 Mar;86(3):282-293. doi: 10.1037/ccp0000282.
OBJECTIVE
Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has been associated with poorer outcomes for both conditions. However, individual differences in depressive symptom trajectories during and after treatment are poorly understood in comorbid insomnia and depression. This study explored the heterogeneity in long-term depression change trajectories, and examined their correlates, particularly insomnia-related characteristics.
METHOD
Participants were 148 adults (age M ± SD = 46.6 ± 12.6, 73.0% female) with insomnia and MDD who received antidepressant pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs about sleep were also assessed.
RESULTS
Growth mixture modeling revealed three trajectories: (a) Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value < .001) and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom reduction during treatment (p values < .001) and low depression severity at posttreatment, but increased severity over follow-up (p value < .001). (c) Optimal-Responders (13.5%) achieved most gains during early treatment (p value < .001), continued to improve (p value < .01) and maintained minimal depression during follow-ups. The classes did not differ significantly on baseline measures or treatment received, but differed on insomnia-related measures after treatment began (p values < .05): Optimal-Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about sleep.
CONCLUSIONS
Three depression symptom trajectories were observed among patients with comorbid insomnia and MDD. These trajectories were associated with insomnia-related constructs after commencing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes. (PsycINFO Database Record
目的
失眠和重性抑郁障碍（MDD）常同时发生，且这种共病与两种疾病的预后均较差相关。然而，在共病失眠和抑郁的治疗期间和治疗后，抑郁症状轨迹的个体差异尚未得到充分理解。本研究探讨了长期抑郁变化轨迹的异质性，并考察了其相关因素，特别是与失眠相关的特征。
方法
148 名患有失眠和 MDD 的成年人（年龄 M ± SD = 46.6 ± 12.6，73.0%为女性）接受了抗抑郁药治疗，并被随机分为认知行为治疗失眠 7 次组或对照条件组，共 16 周，2 年随访。在基线、治疗期间每两周以及此后每 4 个月评估抑郁和失眠严重程度。还评估了睡眠努力和对睡眠的信念。
结果
增长混合物建模显示了三种轨迹：（a）部分反应者（68.9%）在早期治疗期间有中度症状减轻（p 值<.001），并在随访期间保持轻度抑郁。（b）初始反应者（17.6%）在治疗期间有明显的症状减轻（p 值<.001），在治疗后，抑郁严重程度较低，但在随访中加重（p 值<.001）。（c）最佳反应者（13.5%）在早期治疗期间获得了大部分收益（p 值<.001），继续改善（p 值<.01），并在随访期间保持最小的抑郁。这些类别在基线测量或接受的治疗上没有显著差异，但在治疗开始后在与失眠相关的测量上存在差异（p 值<.05）：最佳反应者始终报告最低的失眠严重程度、睡眠努力和无益的睡眠信念。
结论
在患有共病失眠和 MDD 的患者中观察到三种抑郁症状轨迹。这些轨迹与开始治疗后与失眠相关的结构有关。失眠特征的早期变化可能预测长期抑郁结局。
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