Orygen, Melbourne, VIC, Australia.
Centre of Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2021 May;55(5):506-516. doi: 10.1177/0004867421998763. Epub 2021 Mar 15.
Effective treatment of depression is a key target for suicide prevention strategies. However, only around one-third of young people with suicide risk respond to evidence-based treatments. Understanding the trajectory of suicidal ideation, as a marker of suicide risk, over the course of evidence-based treatment for depression might provide insight into more targeted and effective treatments.
This is a secondary analysis of data from the multicentre Youth Depression Alleviation-Combined Treatment trial. A total of 153 young people aged 15-25 years diagnosed with major depressive disorder were randomly assigned in this double-blind, placebo-controlled trial to either cognitive behavioural therapy plus fluoxetine or cognitive behavioural therapy plus placebo. Participants were assessed for depression and suicidal ideation at baseline and at weeks 4, 8 and 12.
Using group-based trajectory modelling, we identified two distinct depression trajectories. The first (Improving; 54.9%; = 83) comprised those who experienced a consistent decline in depression symptoms. The second (Persisting; 45.1%; = 70) comprised those who, despite treatment, still had clinically significant levels of depression by the end of treatment. For suicidal ideation, we identified four distinct trajectories: Non-clinical (15.5%; = 20), Low Improving (47.1%; = 75), High Improving (24.8%; = 38) and High Persisting (12.7%; = 20). Treatment allocation was not significantly associated with trajectory membership for either depression or suicidal ideation.
Understanding the course of depression and suicidal ideation during treatment has important implications for managing suicide risk. The findings suggest that there is an identifiable group of young people for whom enhanced psychological and/or pharmacological intervention might be required to ensure a better treatment response. Specific interventions for those with suicidal ideation may also be prudent from the outset.
The Youth Depression Alleviation-Combined Treatment trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12612001281886).
有效治疗抑郁症是预防自杀策略的关键目标。然而，只有约三分之一有自杀风险的年轻人对基于证据的治疗有反应。了解基于证据的抑郁症治疗过程中自杀意念的轨迹，作为自杀风险的标志物，可能有助于更有针对性和更有效的治疗。
这是多中心青年抑郁缓解联合治疗试验数据的二次分析。这项双盲、安慰剂对照试验共纳入 153 名年龄在 15 至 25 岁之间、被诊断患有重度抑郁症的年轻人，随机分配至认知行为疗法加氟西汀或认知行为疗法加安慰剂组。参与者在基线和第 4、8 和 12 周接受抑郁和自杀意念评估。
使用基于群组的轨迹建模，我们确定了两种不同的抑郁轨迹。第一种（改善型；54.9%，83 人）包括那些抑郁症状持续下降的人。第二种（持续型；45.1%，70 人）包括那些尽管接受了治疗，但在治疗结束时仍有临床显著抑郁水平的人。对于自杀意念，我们确定了四种不同的轨迹：非临床型（15.5%，20 人）、轻度改善型（47.1%，75 人）、高度改善型（24.8%，38 人）和高度持续型（12.7%，20 人）。治疗分配与抑郁或自杀意念的轨迹成员没有显著相关。
了解治疗期间抑郁和自杀意念的过程对管理自杀风险具有重要意义。研究结果表明，有一个可识别的年轻人群体，他们可能需要增强心理和/或药物干预，以确保更好的治疗反应。对于那些有自杀意念的人，从一开始就采取特定的干预措施可能也是明智的。
青年抑郁缓解联合治疗试验前瞻性地在澳大利亚和新西兰临床试验注册中心（ACTRN12612001281886）注册。
