Department of Psychology, Truman State University.
Department of Psychology, University of Notre Dame.
J Consult Clin Psychol. 2019 Jun;87(6):510-520. doi: 10.1037/ccp0000409. Epub 2019 Apr 22.
Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD) producing benefits comparable to pharmacotherapy, but not all patients respond or remit. The purpose of the current analyses was to estimate CT patients' probability of nonresponse and remission from symptom improvement early in treatment.
Data from 2 clinical trials of acute-phase CT for recurrent depression were pooled for analysis (N = 679). Adult outpatients received 16- or 20-session CT protocols. Symptoms were measured repeatedly with the clinician-report Hamilton Rating Scale for Depression (HRSD) and Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Outcomes at exit from CT were nonresponse (<50% reduction in HRSD scores) and remission (no MDD and HRSD score ≤6).
The nonresponse rate was 45.7%, and the remission rate was 33.4%. In logistic regression models, improvements on the HRSD or IDS-SR from intake to CT Sessions 3, 5, 7, 9, or 11 significantly predicted both outcomes, with prediction gaining in accuracy in later sessions. Clinician and self-report assessments yielded similar results. Prediction of outcomes replicated across data sets. Patients with no symptom improvement by CT Session 9 (Week 5) had ≤10% probability of remission and >75% probability of nonresponse.
Outcomes of CT for depression are predictable from early symptom changes. Clinicians may find nonresponse and remission probability estimates useful in the informed consent process and in choosing whether to continue, augment, or switch treatments for CT patients with recurrent MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
急性期认知疗法（CT）是一种有效的治疗重度抑郁症（MDD）的方法，其疗效可与药物治疗相媲美，但并非所有患者都有反应或缓解。目前分析的目的是估计 CT 患者在治疗早期从症状改善中无反应和缓解的可能性。
对 2 项复发性抑郁症急性期 CT 的临床试验数据进行汇总分析（N=679）。成年门诊患者接受 16 或 20 节 CT 方案。使用临床医生报告的汉密尔顿抑郁评定量表（HRSD）和抑郁症状自评量表-自我报告（IDS-SR）反复测量症状。CT 结束时的结局为无反应（HRSD 评分降低<50%）和缓解（无 MDD，HRSD 评分≤6）。
无反应率为 45.7%，缓解率为 33.4%。在逻辑回归模型中，从入院到 CT 第 3、5、7、9 或 11 次治疗时 HRSD 或 IDS-SR 的改善均显著预测了这两种结局，且在后期治疗中预测准确性提高。临床医生和自我报告评估得出了相似的结果。在数据集中复制了对结局的预测。在 CT 第 9 次治疗（第 5 周）时无任何症状改善的患者，缓解的可能性≤10%，无反应的可能性>75%。
从早期症状变化可预测 CT 治疗抑郁症的结局。对于复发性 MDD 的 CT 患者，临床医生可能会发现无反应和缓解概率估计值在知情同意过程中以及在决定是否继续、增强或更换 CT 治疗方面很有用。（APA，所有权利保留）。
