Clinical Research Center & Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
Department of Psychiatry and Psychology, Shanghai Deji Hospital Affiliated to Qingdao University, Shanghai, 200331, China.
J Psychiatr Res. 2021 Jun;138:96-102. doi: 10.1016/j.jpsychires.2021.03.063. Epub 2021 Apr 1.
Effective and targeted interventions for improving quality of life (QOL) in addition to achieving 'clinical remission' are imperatives for patients with major depressive disorder (MDD). This study aimed to examine potential predictors and moderators of QOL in depression. Data were obtained from the Algorithm Guided Treatment Strategies for Major Depressive Disorder (AGTs-MDD) study, a multisite, randomized controlled trial composed of 980 depressed patients. Mixed Model Repeated Measures (MMRM) analyses were conducted to identify baseline characteristics associated with QOL overall (predictors) and their interaction effects (moderators). Severe core depressive, anxiety and pain symptoms were found to be independently associated with poor QOL over the 12-week acute phase treatment. Severe depression, severe anxiety or pain symptoms, or severe suicidal ideation predicted a larger improvement of QOL during acute phase treatment, whereas males showed less improvement. None of the putative moderators were identified except for the educational level. Patients with lower educational level showed a larger improvement of QOL in the AGT started with escitalopram (AGT-E) group and AGT started with mirtazapine (AGT-M) group compared to the treatment as usual (TAU) group. These findings may help to instruct informed decision-making for heterogeneous patients with MDD in the view of full recovery.
除了实现“临床缓解”外，针对改善生活质量（QOL）的有效和有针对性的干预措施对于患有重度抑郁症（MDD）的患者来说至关重要。本研究旨在探讨抑郁症患者 QOL 的潜在预测因素和调节因素。数据来自 Algorithm Guided Treatment Strategies for Major Depressive Disorder（AGTs-MDD）研究，这是一项多中心、随机对照试验，共纳入 980 名抑郁患者。采用混合模型重复测量（MMRM）分析来确定与整体 QOL 相关的基线特征（预测因素）及其交互作用（调节因素）。严重核心抑郁、焦虑和疼痛症状被发现与 12 周急性治疗期间的不良 QOL 独立相关。严重抑郁、严重焦虑或疼痛症状或严重自杀意念预测急性治疗期间 QOL 的改善幅度更大，而男性的改善幅度较小。除了教育程度外，没有发现其他假定的调节因素。与常规治疗组相比，接受依西酞普兰（AGT-E）或米氮平（AGT-M）起始的 AGT 治疗的患者，教育程度较低的患者 QOL 改善幅度更大。这些发现可能有助于指导对 MDD 异质患者进行全面康复的知情决策。
