Veterans Affairs (VA) San Diego Healthcare System, San Diego, California, USA.
Veterans Medical Research Foundation, San Diego, California, USA.
J Trauma Stress. 2020 Jun;33(3):345-352. doi: 10.1002/jts.22503. Epub 2020 Mar 26.
Posttraumatic stress disorder (PTSD) and depression are highly comorbid within the veteran population. Research studies have yielded divergent findings regarding the effect of depression on PTSD treatment outcomes. The present study investigated the influence of pretreatment depression severity on PTSD and depression symptom trajectories among 85 older (i.e., ≥ 60 years) male veterans with military-related PTSD who received either prolonged exposure or relaxation training as part of a randomized controlled trial. Participants were categorized as having no/mild depression (n = 23) or moderate/severe depression (n = 62). The PTSD Checklist (PCL-S) and Patient Health Questionnaire (PHQ-9) were completed at pretreatment, each of 12 therapy sessions, posttreatment, and 6-month follow-up, for a total of up to 15 data points per participant. Multilevel modeling (MLM) was used to evaluate the impact of pretreatment depression severity on piecewise symptom trajectories (i.e., active treatment and follow-up periods) over time and to determine whether treatment condition moderated the trajectories. The final MLM results showed significant main effects of depression severity on PCL-S scores, B = 10.84, p = .043 and PHQ-9 scores, B = 7.09, p = .001, over time. No significant interactions emerged for either the PCL-S or PHQ-9, indicating that although older veterans with more severe depression endorsed higher PTSD and depression scores across time, the symptom trajectories were not moderated by depression severity, treatment condition, or their interaction.
创伤后应激障碍（PTSD）和抑郁症在退伍军人中高度共病。研究表明，抑郁症对 PTSD 治疗结果的影响存在分歧。本研究调查了 85 名年龄较大（即≥60 岁）男性退伍军人中，抑郁严重程度对 PTSD 和抑郁症状轨迹的影响，这些退伍军人患有与军事相关的 PTSD，他们接受了延长暴露或放松训练作为一项随机对照试验的一部分。参与者分为无/轻度抑郁（n=23）或中度/重度抑郁（n=62）。在治疗前、12 次治疗会议中的每次治疗前、治疗后和 6 个月随访时，使用 PTSD 检查表（PCL-S）和患者健康问卷（PHQ-9）进行评估，每个参与者最多可获得 15 个数据点。多级模型（MLM）用于评估治疗前抑郁严重程度对分段症状轨迹（即积极治疗和随访期）随时间的影响，并确定治疗条件是否调节了轨迹。最终的 MLM 结果显示，抑郁严重程度对 PCL-S 评分有显著的主要影响，B=10.84，p=0.043，对 PHQ-9 评分有显著的主要影响，B=7.09，p=0.001。PCL-S 或 PHQ-9 均未出现显著的交互作用，表明尽管患有更严重抑郁症的老年退伍军人在整个时间内的 PTSD 和抑郁评分更高，但症状轨迹不受抑郁严重程度、治疗条件或它们的交互作用的调节。
