Abas Melanie Amna, Weiss Helen Anne, Simms Victoria, Verhey Ruth, Rusakaniko Simbarashe, Araya Ricardo, Chibanda Dixon
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK.
EClinicalMedicine. 2020 May 27;23:100333. doi: 10.1016/j.eclinm.2020.100333. eCollection 2020 Jun.
There is a lack of data from low- and middle-income countries on whether anxiety independently predicts a more chronic course for depression.
We undertook secondary data analysis of a cluster randomised controlled trial in Zimbabwe which had tested the effectiveness of the Friendship Bench intervention for common mental disorders compared to enhanced usual care. Inclusion for the current study was participants from the trial who had probable major depression at baseline, defined as scoring => 11 on the locally validated Patient Health Questionnaire (PHQ9). This emerged to be 354 of the original 573 (61.78%) of the original trial sample. Anxiety was measured using the locally validated cut-point on the Generalised Anxiety Disorder scale (GAD-7). Persistent depression was defined as scoring => 11 on the PHQ-9 at six-months follow-up. Analysis in Stata 15 used random-effects logistic regression to adjust for clustering by clinic.
Of the 354 participants who were eligible for treatment, 329 (92·9%) completed 6-month follow-up assessment. 37% of the trial sample had persistent depression at 6-months follow-up; 59% in the control arm and 17% in the intervention arm. Co-morbid anxiety present at trial baseline was independently associated with persistent depression after adjusting for age, gender and baseline depression severity (adjusted OR = 2·83, 95% CI 1·32-6·07). There was no evidence of effect modification by trial arm. Baseline depression severity also predicted persistent depression. Treatment for depression in low and middle-income countries (LMIC) should be directed towards those with greatest need. This includes people with co-morbid anxiety and greater depression severity at initial assessment who are less likely to remit at six months. Advice on coping with anxiety, psychological treatments which target common anxiety symptoms such as fear, avoidance, excessive worry and intrusive thoughts, and Selective Serotonin Reuptake Inhibitors (SSRIs) should be made more widely available in LMIC and offered to those with persistent mixed depression and anxiety.
低收入和中等收入国家缺乏关于焦虑是否能独立预测抑郁症更慢性病程的数据。
我们对津巴布韦的一项整群随机对照试验进行了二次数据分析，该试验比较了友谊长椅干预措施与强化常规护理对常见精神障碍的有效性。纳入本研究的是试验中的参与者，他们在基线时可能患有重度抑郁症，定义为在当地验证的患者健康问卷（PHQ9）上得分≥11分。这在最初试验样本的573名参与者中占354名（61.78%）。使用当地验证的广泛性焦虑症量表（GAD-7）切点来测量焦虑。持续性抑郁症定义为在六个月随访时PHQ-9得分≥11分。在Stata 15中进行的分析使用随机效应逻辑回归来调整诊所层面的聚类。
在354名符合治疗条件的参与者中，329名（92.9%）完成了六个月的随访评估。试验样本中有37%在六个月随访时患有持续性抑郁症；对照组为59%，干预组为17%。在调整年龄、性别和基线抑郁严重程度后，试验基线时存在的共病焦虑与持续性抑郁症独立相关（调整后的比值比=2.8, 95%置信区间1.32-6.07）。没有证据表明试验组存在效应修饰。基线抑郁严重程度也可预测持续性抑郁症。低收入和中等收入国家（LMIC）的抑郁症治疗应针对最有需要的人群。这包括在初次评估时患有共病焦虑且抑郁严重程度较高、六个月时缓解可能性较小的人群。关于应对焦虑的建议、针对恐惧、回避、过度担忧和侵入性思维等常见焦虑症状的心理治疗以及选择性5-羟色胺再摄取抑制剂（SSRI）应在低收入和中等收入国家更广泛地提供，并提供给患有持续性混合性抑郁和焦虑的人群。
