患有心境或焦虑障碍请病假人群中焦虑和抑郁症状的轨迹：一项随机对照试验的二次分析。

Trajectories of symptoms of anxiety and depression among people on sick leave with mood or anxiety disorders: Secondary analysis from a randomized controlled trial.

机构信息

CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark.

出版信息

J Psychiatr Res. 2021 May;137:250-257. doi: 10.1016/j.jpsychires.2021.02.040. Epub 2021 Feb 25.

DOI:10.1016/j.jpsychires.2021.02.040

PMID:33714077

Abstract

BACKGROUND

Depression and anxiety are heterogenous disorders often combined into one entity in studies. Few studies have compared trajectories of depression and anxiety among clinically ill. We aimed to identify specific trajectories of depression, and anxiety and predictors of trajectory membership.

METHODS

Latent growth mixture modelling was carried out on data from the IPS-MA trial (n = 261), a supported employment intervention for people with mood or anxiety, to identify trajectories of depression and anxiety. Logistic regression was used to estimate predictors for trajectory membership. Associations between trajectory class and remission of comorbid depression or anxiety and return to work were also tested.

RESULTS

We identified three trajectories of depression and anxiety symptoms respectively; moderate-decreasing (60%), moderate-stable (26%), and low-stable (14%) depression and mild-decreasing (59%), moderate-decreasing (33%), and moderate-stable (8%) anxiety. The depression model showed low precision in class separation (entropy 0.66), hence, predictors of class membership were not estimated. For anxiety, lower age and higher levels of depressive symptoms were associated with a less desirable trajectory. Remission of comorbid depressive symptoms after two years differed significantly between classes (p < 0.000). Fewer had returned to work in the two moderate classes compared to the mild-decreasing anxiety class.

LIMITATIONS

Depression model not reliable. Only 80% of participants from original study included. Not able to distinguish between anxiety disorders.

CONCLUSION

Trajectories of anxiety confirm that, even after two years, a rather large proportion in the moderate-stable class had symptoms of moderate anxiety, moderate comorbid depressive symptoms, and less probability of having returned to work.

TRIAL REGISTRATION

ClinicalTrials.govNCT01721824.

摘要

背景

抑郁和焦虑是异质障碍，在研究中常被合并为一个实体。很少有研究比较过患有临床疾病的抑郁和焦虑的轨迹。我们旨在确定抑郁和焦虑的具体轨迹以及轨迹成员的预测因素。

方法

对 IPS-MA 试验（n=261）的数据进行潜在增长混合模型分析，这是一项针对情绪或焦虑人群的支持性就业干预措施，以确定抑郁和焦虑的轨迹。使用逻辑回归来估计轨迹成员的预测因素。还测试了轨迹类别与共病抑郁或焦虑的缓解以及恢复工作之间的关联。

结果

我们分别确定了抑郁和焦虑症状的三种轨迹；中度下降（60%）、中度稳定（26%）和低度稳定（14%）的抑郁和轻度下降（59%）、中度下降（33%）和中度稳定（8%）的焦虑。抑郁模型的分类精度较低（熵 0.66），因此，没有估计轨迹成员的预测因素。对于焦虑，年龄较低和抑郁症状水平较高与不太理想的轨迹相关。两年后共病抑郁症状的缓解在不同类别之间有显著差异（p<0.000）。与轻度下降的焦虑类相比，在两个中度类中，返回工作的人数较少。