Nationwide Children's Hospital, Big Lots Behavioral Health Services and Division of Child and Family Psychiatry, Columbus, Ohio; The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, Columbus, Ohio.
Creighton University, Department of Psychiatry, Omaha, Nebraska.
J Affect Disord. 2021 Feb 15;281:24-32. doi: 10.1016/j.jad.2020.11.115. Epub 2020 Nov 27.
This naturalistic follow-up study examines outcomes for youth with depression (n = 25) or subsyndromal bipolar disorder (n = 13) 2-5 years after participation in randomized clinical trials (RCTs) of omega-3 fatty acids (Ω3), individual family psychoeducational psychotherapy (IF-PEP), and their combination METHODS: Forty percent (38/95) of RCT families completed a follow-up assessment RESULTS: Relapse rates and conversion to bipolar disorder were consistent with published literature. Original treatment assignment did not impact current functioning. Overall, participants' mood severity, executive functioning, and global functioning continued to be better than at RCT baseline. Depressive symptoms increased significantly from end of RCT. Manic symptom severity, executive functioning, and global functioning remained comparable to end of RCT. The majority of parents and youth reported improved youth emotion regulation skills and family communication. They considered study participation beneficial, with increased understanding of mood disorders being the top reason. Half of youth commenced or continued Ω3 and 58% commenced or continued psychotherapy post-RCT, suggesting some degree of consumer satisfaction; these youth had lower depression severity than other participants.
Only 40% returned to this naturalistic follow-up; they were less likely to have an African-American parent, were of higher income, and youth were more symptomatic at end of RCT than those who did not return CONCLUSIONS: Improvement from RCT baseline continued although depressive symptom severity increased from end of RCT to follow-up. Meaningful improvements in youth and family functioning persisted 2-5 years later. Interventions that prevent relapse or conversion to BPSD are still needed for these vulnerable populations.
本自然随访研究考察了在随机对照试验(RCT)中接受ω-3 脂肪酸(Ω3)、个体家庭心理教育心理治疗(IF-PEP)及其联合治疗的青少年抑郁(n=25)或亚双相情感障碍(n=13)2-5 年后的结局。
40%(38/95)的 RCT 家庭完成了随访评估。
复发率和转为双相情感障碍与已发表文献一致。原始治疗分配并不影响当前的功能。总的来说,参与者的情绪严重程度、执行功能和总体功能继续优于 RCT 基线。抑郁症状从 RCT 结束时显著增加。躁狂症状严重程度、执行功能和总体功能仍与 RCT 结束时相当。大多数父母和青少年报告称,青少年的情绪调节技能和家庭沟通得到改善。他们认为研究参与有益,增加对情绪障碍的了解是首要原因。一半的青少年在 RCT 后开始或继续服用 Ω3,58%的青少年开始或继续接受心理治疗,这表明有一定程度的消费者满意度;这些青少年的抑郁严重程度低于其他参与者。
只有 40%的人返回了这项自然随访研究;他们不太可能有非裔美国父母,收入较高,青少年在 RCT 结束时的症状比未返回的参与者更严重。
尽管从 RCT 基线开始的抑郁症状严重程度从 RCT 结束时增加到随访时,但仍有持续改善。青少年和家庭功能的显著改善在 2-5 年后仍持续存在。这些弱势群体仍需要预防复发或转为 BPSD 的干预措施。