Department of Psychiatry, Dalhousie University, Halifax, Canada.
Department of Psychiatry, Dalhousie University, Halifax, Canada.
J Affect Disord. 2020 Aug 1;273:194-202. doi: 10.1016/j.jad.2020.04.035. Epub 2020 May 3.
Depressed patients with chronic and complex health issues commonly relapse; therefore, examining longer-term outcomes is an important consideration. For treatment resistant depression (TRD), the post-treatment efficacy of time-limited Intensive Short-Term Dynamic Psychotherapy (ISTDP) has been demonstrated but longer-term outcomes and cost-effectiveness are unclear.
In this superiority trial, 60 patients referred to Community Mental Health Teams (CMHT) were randomised to 2 groups (ISTDP=30 and CMHT=30). The primary outcome was Hamilton Depression Rating scale (HAM-D) scores at 18 months. Secondary outcomes included Patient Health Questionnaire (PHQ-9) depression scores and dichotomous measure remission. A health economic evaluation examined mental health costs with quality-adjusted life years (QALYs).
Statistically significant treatment differences in depression previously found at 6 months favouring ISTDP were maintained at 18-month follow-up. Group differences in depression were in the moderate to large range on both the observer rated (Cohen's d = .64) and self-report measures (Cohen's d = .70). At 18 months follow-up the remission rate in ISTDP patients was 40.0%, and 23.4% had discontinued antidepressants. Health economic analysis suggests that ISTDP was more cost-effective than CMHT at 18 months. Probabilistic analysis suggests that there is a 64.5% probability of ISTDP being cost-effective at a willingness to pay for a QALY of $25,000 compared to CMHT at 18 months.
Replication of these findings is necessary in larger samples and future cost analyses should also consider indirect costs.
ISTDP demonstrates long-term efficacy and cost-effectiveness in TRD.
患有慢性和复杂健康问题的抑郁患者常复发；因此，长期疗效是一个重要的考虑因素。对于治疗抵抗性抑郁症（TRD），限时强化短期动态心理治疗（ISTDP）的治疗后疗效已得到证实，但长期疗效和成本效益尚不清楚。
在这项优势试验中，将 60 名转介至社区心理健康团队（CMHT）的患者随机分为 2 组（ISTDP=30 例和 CMHT=30 例）。主要结局是 18 个月时汉密尔顿抑郁量表（HAM-D）评分。次要结局包括患者健康问卷（PHQ-9）抑郁评分和二分法缓解。一项健康经济学评估检查了心理健康成本与质量调整生命年（QALYs）。
先前在 6 个月时发现的具有统计学意义的治疗差异有利于 ISTDP，在 18 个月随访时仍得到维持。在观察者评定（Cohen's d=0.64）和自我报告测量（Cohen's d=0.70）上，两组在抑郁方面的差异均处于中等至较大范围。在 18 个月随访时，ISTDP 患者的缓解率为 40.0%，23.4%停止使用抗抑郁药。健康经济学分析表明，在 18 个月时，ISTDP 比 CMHT 更具成本效益。概率分析表明，在愿意支付每 QALY 25,000 美元的情况下，与 18 个月时的 CMHT 相比，ISTDP 具有成本效益的可能性为 64.5%。
在更大的样本中复制这些发现是必要的，未来的成本分析还应考虑间接成本。
ISTDP 对 TRD 具有长期疗效和成本效益。
