NHS Greater Glasgow and Clyde, Glasgow, UK.
Institute of Statistics, Biostatistics and Actuarial Sciences, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium.
BMC Psychiatry. 2020 Mar 16;20(1):125. doi: 10.1186/s12888-020-02532-0.
Clinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which "symptom severity measures" and "complexity measures" assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment.
Subjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of "case complexity" (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ.
298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment.
These results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.
成人抑郁症临床指南建议在常规护理中使用结局测量和阶梯式护理模型。这些措施基于症状严重程度，但治疗反应也可能受到个人和环境因素的影响。本项针对常规临床样本的观察性研究旨在探讨“症状严重程度测量”和“复杂性测量”在多大程度上评估了患者体验的不同方面，以及它们与临床结局（包括治疗中断）的关系。
使用阶梯式护理模型，从转诊到已建立的初级保健心理健康团队的患者中招募有抑郁症状（伴或不伴共病焦虑）的患者。每位参与者完成了三项基线症状测量（患者健康问卷（PHQ）、广泛性焦虑症问卷（GAD）和常规评估临床结局（CORE-10）），以及两项“病例复杂性”评估（明尼苏达州-爱丁堡复杂性评估量表（MECAM）和当地复杂性评估）。还评估了临床医生对治疗完成和患者康复的可能性的看法。结局测量为 PHQ 的脱落和临床改善。
共招募了 298 名患者参加研究，其中 258 名患者有足够的数据集可供分析。研究数据显示，本研究中使用的三种症状严重程度测量（PHQ、GAD 和 CORE-10）似乎在测量与病例复杂性测量（MECAM、既往和当前问题数）相关的特征时，是在测量不同的特征。较高的症状严重程度评分与治疗结束时的改善结局相关，但结局与复杂性测量之间没有关联。临床医生可以比较准确地预测患者退出护理，但无法预测治疗结局。
这些结果突出了在现实环境中，无论是否存在焦虑，脱落使抑郁和焦虑的康复复杂化的程度，以及在规划护理时需要考虑除症状严重程度以外的其他因素。研究结果与越来越多的文献中关于协作式抑郁治疗模式中预后指标的研究结果进行了讨论。
