Assmann Nele, Fassbinder Eva, Schaich Anja, Lee Christopher W, Boterhoven de Haan Katrina, Rijkeboer Marleen, Arntz Arnoud
Department of Psychiatry and Psychotherapy, Lübeck University, 23538 Lübeck, Germany.
Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, 24105 Kiel, Germany.
J Clin Med. 2021 Aug 20;10(16):3708. doi: 10.3390/jcm10163708.
Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.
创伤后应激障碍（PTSD）患者常常伴有其他共病诊断，如重度抑郁症（MDD）和焦虑症（AD）。关于这些共病对PTSD治疗结果影响的研究结果不一。这些研究中所调查的不同治疗方法可能解释了结果的差异。本研究的目的是检验这些共病对两种特定PTSD治疗结果的影响。在一项对155名童年创伤所致PTSD成年患者进行的试验中，将MDD和AD作为预测因素和调节因素进行分析，该试验比较了12节眼动脱敏再处理疗法（EMDR）或意象重述疗法（IR）。主要结局是在八周随访时评估的PTSD症状减轻（临床医生评定的DSM-5创伤后应激障碍量表，CAPS-5），次要结局是自我报告的PTSD症状（事件影响量表，IES-R）。MDD不是治疗结果的预测因素，但确实有显著的调节作用。患有MDD的患者若接受IR治疗，结局更好，而未患MDD的患者在EMDR治疗条件下改善更多。AD未显示出影响。在规划PTSD治疗时考虑共病的MDD似乎对改善治疗结果至关重要。需要更多研究来重复我们的发现，并关注不同类型的PTSD治疗和其他共病。
