美国一项针对伴有 HIV 的青少年抑郁的联合认知行为治疗和药物管理算法治疗的现场随机试验的 48 周结局。

Forty-Eight Week Outcomes of a Site-Randomized Trial of Combined Cognitive Behavioral Therapy and Medication Management Algorithm for Treatment of Depression Among Youth With HIV in the United States.

机构信息

Rhode Island Hospital, Providence, RI.

Alpert Medical School of Brown University, Providence, RI.

出版信息

J Acquir Immune Defic Syndr. 2022 Nov 1;91(3):296-304. doi: 10.1097/QAI.0000000000003058. Epub 2022 Jul 20.

DOI:10.1097/QAI.0000000000003058

PMID:35839439

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9561232/

Abstract

BACKGROUND

Studies suggest that manualized, measurement-guided, depression treatment is more efficacious than usual care but impact can wane. Our study among youth with HIV (YWH), aged 12-24 years at US clinical research sites in the International Maternal Pediatric Adolescent AIDS Clinical Trials Network, found a significant reduction in depressive symptoms among YWH who received a manualized, measurement-guided treatment. This paper reports outcomes up to 24 weeks after the intervention.

METHODS

Eligibility included diagnosis of ongoing nonpsychotic depression. Using restricted randomization, sites were assigned to either combination cognitive behavioral therapy and medication management algorithm tailored for YWH or to enhanced standard of care, which provided psychotherapy and medication management. Site-level mean Quick Inventory for Depression Symptomatology Self-Report (QIDS-SR) scores and proportion of youth with treatment response (>50% decrease from baseline) and remission (QIDS-SR ≤ 5) were compared across arms using t tests.

RESULTS

Thirteen sites enrolled 156 YWH, with baseline demographic factors, depression severity, and HIV disease status comparable across arms. At week 36, the site-level mean proportions of youth with a treatment response and remission were greater at combination cognitive behavioral therapy and medication management algorithm sites (52.0% vs. 18.8%, P = 0.02; 37.9% vs. 19.4%, P = 0.05), and the mean QIDS-SR was lower (7.45 vs. 9.75, P = 0.05). At week 48, the site-level mean proportion with a treatment response remained significantly greater (58.7% vs. 33.4%, P = 0.047).

CONCLUSIONS

The impact of manualized, measurement-guided cognitive behavioral therapy and medication management algorithm tailored for YWH that was efficacious at week 24 continued to be evident at weeks 36 and 48.

摘要

背景

研究表明，针对抑郁症的手册化、测量指导治疗比常规护理更有效，但效果可能会减弱。我们在国际母婴青少年艾滋病临床试验网络（International Maternal Pediatric Adolescent AIDS Clinical Trials Network）的美国临床研究点对年龄在 12 至 24 岁的 HIV 青少年（YWH）进行了一项研究，发现接受手册化、测量指导治疗的 YWH 其抑郁症状显著减轻。本文报告了干预后 24 周的结果。

方法

入选标准包括诊断为持续性非精神病性抑郁症。通过限制随机化，将各研究点分配至针对 YWH 的联合认知行为疗法和药物管理算法组或强化标准护理组，后者提供心理治疗和药物管理。采用 t 检验比较各治疗组间的研究点水平平均快速抑郁症状自评量表（Quick Inventory for Depression Symptomatology Self-Report，QIDS-SR）评分和有治疗反应（与基线相比下降超过 50%）及缓解（QIDS-SR≤5）的青少年比例。

结果

13 个研究点共纳入了 156 名 YWH，各组间的基线人口统计学因素、抑郁严重程度和 HIV 疾病状况相当。在第 36 周时，联合认知行为疗法和药物管理算法组的青少年有治疗反应和缓解的比例较高（分别为 52.0%和 37.9%，P=0.02；18.8%和 19.4%，P=0.05），且 QIDS-SR 评分较低（分别为 7.45 和 9.75，P=0.05）。在第 48 周时，治疗反应的研究点水平平均比例仍显著更高（58.7%和 33.4%，P=0.047）。