抑郁：纤维肌痛不良结局的可改变风险因素。
Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia.
机构信息
Mayo Clinic Florida, Jacksonville, FL, USA.
University of Houston, Houston, TX, USA.
出版信息
J Prim Care Community Health. 2022 Jan-Dec;13:21501319221120738. doi: 10.1177/21501319221120738.
BACKGROUND
About 4 out of 10 fibromyalgia patients suffer from depression. The European Alliance of Associations for Rheumatology (EULAR) guidelines recommend using antidepressants to treat fibromyalgia.
OBJECTIVE
To determine predictors of improved outcomes following a multicomponent treatment program.
DESIGN
We designed this longitudinal treatment outcome study to evaluate the prevalence of depression symptoms in patients diagnosed with fibromyalgia at a tertiary care facility, and the impact of depression on functional outcomes after completing a multicomponent fibromyalgia treatment program.
SETTING
Tertiary care center.
PATIENTS
This study included 411 adult patients with fibromyalgia who completed a multicomponent treatment program for fibromyalgia. Expert physicians performed comprehensive evaluations following American College of Rheumatology (ACR) criteria to confirm fibromyalgia before referral to the program.
INTERVENTION
An intensive outpatient multicomponent treatment program consisting of 16 hours of cognitive behavioral strategies served as the intervention.
MEASUREMENTS
Functional status was assessed using the Fibromyalgia Impact Questionnaire Revised (FIQR). Depression was evaluated with the Center for Epidemiologic Study of Depression (CES-D) measure. Measures were administered prior to participation in the program and approximately 5 months following completion of the program.
RESULTS
The cohort had a high prevalence of depressive symptoms (73.2% had depression at admission). Higher depression scores at baseline predicted poorer outcomes following multi-component treatment. Effectively treated depression resulted in improved functioning at follow-up.
LIMITATIONS
Findings limited to tertiary care center cohort of fibromyalgia patients. Patients did not undergo a structured clinical diagnostic interview to diagnose depression.
CONCLUSIONS
The current data links depression to poorer outcomes in patients with fibromyalgia. Depression is an important modifiable factor in the management of fibromyalgia. Guidelines should reflect the importance of assessing and effectively treating depression at the time of diagnosis of fibromyalgia, to improve functional outcomes.
REGISTRATION
Specific registry and specific study registration number-Institutional Review Board-(IRB# 19-000495).
FUNDING SOURCE
No funding.
背景
约每 10 名纤维肌痛患者中就有 4 名患有抑郁症。欧洲风湿病联盟（EULAR）指南建议使用抗抑郁药治疗纤维肌痛。
目的
确定多组分治疗方案后改善结果的预测因素。
设计
我们设计了这项纵向治疗结果研究，以评估在三级保健机构诊断为纤维肌痛的患者中出现抑郁症状的患病率，以及在完成多组分纤维肌痛治疗方案后抑郁对功能结果的影响。
地点
三级保健中心。
患者
这项研究包括 411 名完成多组分纤维肌痛治疗方案的成年纤维肌痛患者。在转诊到该方案之前，专家医生根据美国风湿病学会（ACR）标准进行全面评估，以确认纤维肌痛。
干预
作为干预措施，提供了 16 小时的认知行为策略强化门诊多组分治疗方案。
测量
使用纤维肌痛影响问卷修订版（FIQR）评估功能状态。使用流行病学研究中心抑郁量表（CES-D）评估抑郁。在参加该方案之前和完成该方案大约 5 个月后进行了测量。
结果
该队列的抑郁症状发生率很高（73.2%的患者在入院时患有抑郁症）。基线时较高的抑郁评分预示着多组分治疗后较差的结果。有效治疗的抑郁症可改善随访时的功能。
局限性
仅限于三级保健中心纤维肌痛患者队列的研究结果。患者未接受结构化临床诊断访谈以诊断抑郁症。
结论
目前的数据将抑郁与纤维肌痛患者的较差结局联系起来。抑郁症是纤维肌痛管理中的一个重要可改变因素。在纤维肌痛的诊断时，指南应反映评估和有效治疗抑郁症的重要性，以改善功能结局。
注册
特定注册表和特定研究注册号-机构审查委员会（IRB# 19-000495）。
资金来源
无资金。
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