Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands; Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
J Affect Disord. 2019 Mar 15;247:81-87. doi: 10.1016/j.jad.2018.12.035. Epub 2018 Dec 18.
The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment.
We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score.
BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75).
A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.
本研究旨在提高临床医生对治疗早期抑郁和焦虑障碍患者治疗过程延长的识别能力。
我们对 2007 年至 2011 年间在精神科专科护理环境中接受治疗的 1225 名患有抑郁或焦虑障碍的成年患者进行了队列研究，这些患者在 6 个月内至少有两次Brief Symptom Inventory（BSI）评估。我们采用逻辑回归模型，根据基线年龄、性别、种族、教育程度、婚姻状况、住房状况、就业状况、精神共病和基线及首次随访 BSI 评分来预测延长治疗过程（>2 年）。基于回归系数，我们提出了一种易于使用的风险预测评分。
BSI 首次随访结果证明对抑郁和焦虑障碍均具有很强的预测能力（OR=2.17（95%CI95% 1.73-2.74）；OR=2.52（95%CI95% 1.86-3.23））。最终的风险预测评分包括抑郁障碍的 BSI 首次随访和共病轴 II 障碍，焦虑障碍则包括 BSI 首次随访和年龄。对于抑郁障碍，在得分最高的 28%的患者中，延长治疗过程的阳性预测值为 60%（敏感性 0.38，特异性 0.81）。对于焦虑障碍，在得分最高的 35%的患者中，延长治疗过程的阳性预测值为 52%（敏感性 0.55，特异性 0.75）。
在 2-6 个月随访时症状水平较高是延长治疗过程的强烈预测因素。这有助于及早识别治疗过程延长风险较高的患者；通过自我评估的症状严重程度，以相对简单的方式实现。
