Saunders Rob, Cohen Zachary D, Ambler Gareth, DeRubeis Robert J, Wiles Nicola, Kessler David, Gilbody Simon, Hollon Steve D, Kendrick Tony, Watkins Ed, Richards David, Brabyn Sally, Littlewood Elizabeth, Sharp Debbie, Lewis Glyn, Pilling Steve, Buckman Joshua E J
Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational & Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
Department of Psychiatry, University of California, Los Angeles, CA 90095, USA.
J Pers Med. 2021 Dec 4;11(12):1295. doi: 10.3390/jpm11121295.
Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment.
Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care.
Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24-6.87), chronic course = 2.27 (1.27-4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16-5.40), chronic course = 1.98 (1.16-3.37)).
Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
亚组分析方法有可能为抑郁症患者的治疗决策提供支持。但此类方法尚未用于研究抑郁症的持续病程或治疗后复发的可能性。
对7项随机对照试验中个体参与者的数据进行分析。采用潜在剖面分析根据基线特征确定亚组。探讨各亚组与持续慢性抑郁症以及治疗后长达一年复发几率之间的关联。针对接受抗抑郁药治疗、心理治疗和常规护理的患者，在各亚组内研究结局差异。
确定了7个亚组；基线时症状严重程度较高且焦虑和抑郁持续时间较长的亚组复发和患慢性抑郁症的风险更高。亚组五（可能抑郁症和焦虑持续时间长、症状中度严重且既往使用过抗抑郁药）的成员接受心理治疗似乎有更好的结局：抗抑郁药与心理治疗相比（复发的OR（95%CI）=2.92（1.24 - 6.87），慢性病程=2.27（1.27 - 4.06））以及常规护理与心理治疗相比（复发=2.51（1.16 - 5.40），慢性病程=1.98（1.16 - 3.37））。
结局较差风险较高的亚组可能受益于更强化的治疗和频繁监测。亚组五的患者可能从心理治疗中比从其他治疗中获益更多。
