Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, the Netherlands; Parnassia Group, PsyQ Haaglanden, Department of Mood Disorders, The Hague, the Netherlands.
Antes/Parnassia Psychiatric Institute, Rotterdam, the Netherlands.
J Affect Disord. 2023 Feb 1;322:205-211. doi: 10.1016/j.jad.2022.11.011. Epub 2022 Nov 11.
Long-term untreated major depressive disorder (MDD) is associated with a less favorable clinical course. Waiting time, defined as the interval between diagnostic workup and treatment initiation, may be clinically relevant given the prolongation of the pre-existing duration of untreated MDD. However, it is currently unknown whether and to what extent waiting time affects treatment course in routine outpatient care.
Retrospectively extracted data from 715 outpatients with MDD who received naturalistic outpatient MDD treatment were examined. Treatment outcome was defined as the difference in depression severity at the start of treatment and six months thereafter. Clinical course during waiting time was defined by the difference in severity at diagnostic workup and at treatment initiation. We analyzed the association between waiting time and treatment outcome and between waiting time and clinical course during this waiting time using multivariable regression analyses. We adjusted for severity and suicidality as potential confounders.
An increased duration of the waiting time was associated with a less favorable treatment outcome (B = 0.049, SE = 0.019, p = 0.01). This association persisted after adjustment for potential confounders (B = 0.053, SE = 0.02, p = 0.01). No association was found between length of waiting time and clinical course during waiting time.
Strict definitions resulted in smaller sample sizes for the final analyses. The uncontrolled design may be questionable to definitively establish the impact of waiting time on treatment outcome.
A prolonged waiting time is significantly associated with less favorable treatment outcome. Reduction of waiting time deserves priority in depression treatment planning to improve clinical outcomes.
未经治疗的长期重度抑郁症（MDD）与更不利的临床病程相关。等待时间（从诊断评估到开始治疗的间隔）可能具有临床意义，因为未治疗的 MDD 持续时间已经延长。然而，目前尚不清楚等待时间是否以及在何种程度上影响常规门诊治疗中的治疗过程。
回顾性分析了 715 名接受自然主义门诊 MDD 治疗的 MDD 门诊患者的数据。治疗结果定义为治疗开始时和六个月后的抑郁严重程度差异。等待时间内的临床病程通过诊断评估时和开始治疗时的严重程度差异来定义。我们使用多变量回归分析来分析等待时间与治疗结果之间的关系，以及等待时间与等待时间内临床病程之间的关系。我们调整了严重程度和自杀意念作为潜在的混杂因素。
等待时间的延长与治疗结果较差相关（B=0.049，SE=0.019，p=0.01）。在调整了潜在混杂因素后，这种关联仍然存在（B=0.053，SE=0.02，p=0.01）。等待时间的长短与等待时间内的临床病程之间没有关联。
严格的定义导致最终分析的样本量较小。非控制设计可能值得商榷，无法明确确定等待时间对治疗结果的影响。
较长的等待时间与治疗结果较差显著相关。减少等待时间应优先考虑抑郁症治疗计划，以改善临床结果。
