伴发的脊柱疼痛对抑郁患者参与工作和接受短程或短程心理治疗后达到临床缓解的影响。一项为期两年的随访的随机对照试验的二次分析。
The impact of comorbid spinal pain in depression on work participation and clinical remission following brief or short psychotherapy. Secondary analysis of a randomized controlled trial with two-year follow-up.
机构信息
Division of Mental Health & Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
Division Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway.
出版信息
PLoS One. 2022 Aug 22;17(8):e0273216. doi: 10.1371/journal.pone.0273216. eCollection 2022.
OBJECTIVES
This explorative study analyses the influence of baseline comorbid long-lasting spinal pain (CSP) on improvement of long term work participation and clinical remission of mental health illness following either brief coping-focussed or short-term psychotherapy for depression. Whether type of treatment modifies outcome with or without CSP is also analysed.
DESIGN
A secondary post hoc subgroup analysis of a pragmatic randomised controlled trial.
INTERVENTIONS
Brief or standard short psychotherapy.
METHODS
Based on baseline assessment, the sample was subdivided into a subgroup with and a subgroup without CSP. Work participation and clinical remission of depression and anxiety were assessed as treatment outcome at two-year follow-up. Simple and multivariate logistic regression analyses, across the intervention arms, were applied to evaluate the impact of CSP on treatment outcome. Selected baseline variables were considered as potential confounders and included as variates if relevant. The modifying effect of CSP on treatment outcome was evaluated by including intervention modality as an interaction term.
MAIN RESULTS
Among the 236 participants with depressive symptoms, 83 participants (35%) were identified with CSP. In simple logistic regression analysis, CSP reduced improvements on both work participation and clinical remission rate. In the multivariate analysis however, the impact of CSP on work participation and on clinical remission were not significant after adjusting for confounding variables. Reduction of work participation was mainly explained by the higher age of the CSP participants and the reduced clinical remission by the additional co-occurrence of anxiety symptoms at baseline. The occurrence of CSP at baseline did not modify long term outcome of brief compared to short psychotherapy.
CONCLUSIONS
CSP at baseline reduced work participation and worsened remission of mental health symptoms two-year following psychotherapy. Older age and more severe baseline anxiety are associated to reduced effectiveness. Type of psychotherapy received did not contribute to differences.
目的
本探索性研究分析了基线共存的长期慢性疼痛（CSP）对接受短期聚焦应对或短期心理治疗的抑郁患者长期工作参与和心理健康疾病临床缓解的影响。还分析了 CSP 是否会改变治疗效果。
设计
一项实用随机对照试验的二次事后亚组分析。
干预措施
简短或标准短期心理治疗。
方法
根据基线评估，将样本分为 CSP 存在和不存在的亚组。在两年随访时，评估工作参与度和抑郁及焦虑的临床缓解情况作为治疗结果。采用简单和多元逻辑回归分析，跨干预组评估 CSP 对治疗结果的影响。选择基线变量作为潜在混杂因素，如果相关，则将其作为变量纳入。通过将干预模式作为交互项，评估 CSP 对治疗结果的修饰作用。
主要结果
在 236 名有抑郁症状的参与者中，83 名（35%）被确定有 CSP。在简单逻辑回归分析中，CSP 降低了工作参与度和临床缓解率的改善。然而，在多元分析中，在调整混杂变量后，CSP 对工作参与度和临床缓解率的影响并不显著。工作参与度的降低主要归因于 CSP 参与者年龄较大，以及基线时焦虑症状的额外共病导致临床缓解率降低。基线时 CSP 的发生并没有改变短期心理治疗与简短心理治疗的长期疗效。
结论
基线时的 CSP 降低了心理治疗两年后工作参与度，并恶化了心理健康症状的缓解。年龄较大和基线时更严重的焦虑与疗效降低有关。所接受的心理治疗类型没有产生差异。
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