Fornaro M, Novello S, Fusco A, Anastasia A, De Prisco M, Mondin A M, Mosca P, Iasevoli F, de Bartolomeis A
Section of Psychiatry - Unit on Treatment-Resistant Disorders, Department of Neuroscience, Reproductive Sciences, and Dentistry, University School of Medicine Federico II, Naples, Italy.
National Healthcare System, Milan, Italy.
J Psychiatr Res. 2021 Apr;136:522-528. doi: 10.1016/j.jpsychires.2020.10.025. Epub 2020 Oct 22.
Drop-out from follow-up visits carries significant burden for people diagnosed with depression. The present study assesses multiple clinical moderators of drop-out among depressed outpatients. We retrospectively followed-up 131 outpatients over 6 months: 78 major depressive disorder (MDD), and 53 bipolar disorder (BD-I = 24; BD-II = 29) patients diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Participants were assessed with standard rating scales administered by experienced psychiatrists. Upon descriptive and Cox regression analyses, 17/53 BDs (32%) dropped-out; the overall survival time until drop-out was 57.94 ± 17.79 days. BD drop-outs were younger, had an earlier age at onset, shorter illness duration, lower rates of lifetime obsessive-compulsive disorder/suicidal behavior, higher rates of substance use disorder (SUD), anxious and mixed features of depression compared to BDs attending up to six months. Among MDD patients, 10/78 cases (13%) dropped-out by month-6 with an average survival of 42.40 ± 16.45 days. Earlier age of onset, younger age, positive family history for mood disorders, lower rates of lifetime generalized anxiety disorder were significantly more frequent among drop-outs than completers, as opposite to SUD, and lifetime recurrent depression. Older age predicted lower drop-out among BDs and MDDs, although with almost null hazard ratio (HR) = 0.928, p < 0.01 vs. HR = 0.941, p < 0.01, respectively. Higher rates of lifetime SUD predicted higher drop-out rates by month-6 among MDDs (HR = 5.477, p = 0.02). Limitations of the study: retrospective design, small sample size, lack of objective measures of treatment-adherence/mood rating during follow-up. Drop-out is common in the real-world setting, warranting specific interventions since the beginning of the treatment.
随访失访给抑郁症患者带来了沉重负担。本研究评估了门诊抑郁症患者失访的多种临床调节因素。我们对131名门诊患者进行了为期6个月的回顾性随访：78例重度抑郁症（MDD）患者和53例双相情感障碍（BD-I = 24；BD-II = 29）患者，均根据《精神疾病诊断与统计手册》第五版进行诊断。参与者由经验丰富的精神科医生使用标准评定量表进行评估。经过描述性分析和Cox回归分析，53例双相情感障碍患者中有17例（32%）失访；失访前的总生存时间为57.94±17.79天。与随访6个月的双相情感障碍患者相比，双相情感障碍失访者更年轻，起病年龄更早，病程更短，终生强迫症/自杀行为发生率更低，物质使用障碍（SUD）发生率更高，有焦虑和混合性抑郁特征。在重度抑郁症患者中，到第6个月时，78例中有10例（13%）失访，平均生存期为42.40±16.45天。与完成随访者相比，失访者起病年龄更早、年龄更小、有情绪障碍家族史阳性、终生广泛性焦虑症发生率更低的情况更为常见，与物质使用障碍和终生复发性抑郁症情况相反。年龄较大预示着双相情感障碍和重度抑郁症患者失访率较低，尽管危险比（HR）几乎为零，分别为HR = 0.928，p < 0.01和HR = 0.941，p < 0.01。终生物质使用障碍发生率较高预示着重度抑郁症患者到第6个月时失访率较高（HR = 5.477，p = 0.02）。研究局限性：回顾性设计、样本量小、随访期间缺乏治疗依从性/情绪评定的客观测量方法。在现实环境中失访很常见，因此从治疗开始就需要采取特定干预措施。
