Indiana University, Bloomington, IN; Brown University School of Public Health, Providence, RI.
Indiana University, Bloomington, IN; Kaiser Permanente Washington Health Research Institute, Seattle, WA; University of Washington School of Medicine, Seattle.
J Am Acad Child Adolesc Psychiatry. 2019 Mar;58(3):319-328. doi: 10.1016/j.jaac.2018.07.908. Epub 2019 Jan 8.
Depression is the most prominent mental health disorder among youth and has a profound impact with respect to morbidity and mortality if not addressed. The Treatment for Adolescent Depression Study (TADS) is one of the largest randomized controlled trials that compared the effectiveness of four treatments: cognitive-behavioral therapy (CBT); fluoxetine (FLX); combined cognitive-behavioral and fluoxetine treatment (COMB); and placebo (PBO). However, meaningful heterogeneous treatment courses are masked by these group mean comparisons of treatment impact. The present study sought to characterize the acute phase symptom trajectories of the depressed teens enrolled in TADS and to explore predictors of these trajectories, including TADS treatment condition.
The TADS sample of 439 adolescent participants diagnosed with major depressive disorder was subjected to growth mixture modeling (GMM) to evaluate subgroups of adolescents with unique trajectories of depression symptom change.
Growth mixture modeling revealed three unique classes of adolescents: (1) a high-severity class with early significant improvement; (2) a high-severity class with limited symptom change; and (3) a moderate severity class with late significant improvement. Baseline predictors of class membership included treatment condition, sex, age, stage of change, depression severity, number of comorbid disorders, hopelessness, melancholia, suicidality, and cognitive distortions.
Results of this study may have implications for the selection of which treatment to use for which depressed adolescent.
Treatment for Adolescents With Depression Study (TADS); https://clinicaltrials.gov/; NCT00006286.
抑郁症是青少年中最突出的心理健康障碍，如果得不到解决，会对发病率和死亡率产生深远影响。青少年抑郁症治疗研究（TADS）是规模最大的随机对照试验之一，比较了四种治疗方法的有效性：认知行为疗法（CBT）；氟西汀（FLX）；认知行为与氟西汀联合治疗（COMB）；和安慰剂（PBO）。然而，这些组间治疗效果的比较掩盖了有意义的异质治疗过程。本研究旨在描述 TADS 中抑郁青少年的急性期症状轨迹，并探讨这些轨迹的预测因素，包括 TADS 治疗条件。
对被诊断为重度抑郁症的 439 名青少年参与者的 TADS 样本进行增长混合建模（GMM），以评估具有独特抑郁症状变化轨迹的青少年亚组。
增长混合建模揭示了三种独特的青少年群体：（1）早期显著改善的高严重程度群体；（2）严重程度有限的高严重程度群体；（3）晚期显著改善的中度严重程度群体。类别的基线预测因素包括治疗条件、性别、年龄、改变阶段、抑郁严重程度、共病障碍数量、绝望、忧郁、自杀意念和认知扭曲。
本研究结果可能对选择哪种治疗方法治疗哪种抑郁青少年具有启示意义。
青少年抑郁症治疗研究（TADS）；https://clinicaltrials.gov/；NCT00006286。
