乳腺癌诊断后针对抑郁风险目标的预防干预：设计与单臂先导研究。
A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study.
机构信息
Department of Psychiatry, University of Arizona, Tucson, Arizona.
Department of Psychology, University of Arizona, Tucson, Arizona.
出版信息
Psychooncology. 2019 Apr;28(4):880-887. doi: 10.1002/pon.5037. Epub 2019 Mar 15.
OBJECTIVE
Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression.
METHODS
We identified mindful emotion awareness, along with approach and avoidance strategies for cancer-related coping and emotion regulation, as targets for a preventive intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Patients' preferences for individual, in-person, and time-efficient sessions informed the design. Patients at risk for depression received a 6-week, 5-hour intervention with daily exercises. Intervention targets were assessed at baseline, before each session, and 4-weeks post intervention. Mixed effects analysis of variance (ANOVA) assessed change over the follow-up period, controlling for age, partnered status, and disease stage.
RESULTS
Fifty-five percent (40/72) of women screened within 6 months of diagnosis had elevated depression risk. Of these, 24 (60%) signed consent. Sixteen received intervention after five were excluded for current depressive disorder, cognitive impairment, or death. Three dropped out. Ninety-eight percent attendance and 77% practice days indicated feasibility. Effect sizes (Cohen's d) corrected for regression to the mean (RTM) were 0.82 for cancer-related acceptance coping, 0.65 for cancer-related emotional expression, and 0.32 and 0.42 for decreased cancer-related avoidance coping and depressive symptoms, respectively. Effect sizes for variables lacking data to correct for RTM were 1.0, 0.7, and 0.5 for decreased rumination, experiential avoidance, and fear of depression, respectively, and 1.3, 0.6, and 0.4 for increased cognitive flexibility, distress tolerance, and describing/not judging emotions, respectively.
CONCLUSIONS
The feasibility of this intervention and malleability of its targets support its further investigation.
目的
应用美国国立卫生研究院（NIH）分期模型设计并测试预防乳腺癌伴抑郁风险患者抑郁的干预措施。
方法
我们确定了正念情绪意识，以及与癌症相关的应对和情绪调节的接近和回避策略，作为改编自跨诊断情绪障碍统一治疗方案的预防干预的目标。患者对个人、面对面和省时会议的偏好为设计提供了信息。有抑郁风险的患者接受了为期 6 周、5 小时的干预，每天进行练习。在基线、每次治疗前和干预后 4 周评估干预目标。采用混合效应方差分析（ANOVA）评估了随访期间的变化，控制了年龄、伴侣状况和疾病分期。
结果
在诊断后 6 个月内筛查的 72 名女性中，有 55%（40/72）有较高的抑郁风险。其中 24 名（60%）签署了同意书。在排除了 5 名因当前抑郁障碍、认知障碍或死亡而无法参加的患者后，有 16 名患者接受了干预。有 3 名患者中途退出。98%的出勤率和 77%的练习天数表明该干预具有可行性。校正回归均值（RTM）的效应大小（Cohen's d）分别为 0.82（癌症相关接受应对）、0.65（癌症相关情绪表达）和 0.32（癌症相关回避应对减少）和 0.42（抑郁症状减少）。对于缺乏校正 RTM 数据的变量，效应大小分别为 1.0（减少沉思）、0.7（减少体验回避）和 0.5（减少对抑郁的恐惧）和 1.3（增加认知灵活性）、0.6（增加痛苦容忍度）和 0.4（描述/不评判情绪）。
结论
该干预措施的可行性和目标的可调整性支持进一步研究。
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