Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Alcohol. 2023 May;108:44-54. doi: 10.1016/j.alcohol.2022.11.005. Epub 2022 Dec 5.
We investigated whether latent trajectories of anxiety and depressive symptoms were associated with clinically relevant variables including treatment attrition among individuals seeking treatment for alcohol use. Participants were drawn from 78 addiction treatment centers and included individuals in treatment for alcohol use, had in-treatment data, and screened positive for anxiety (n = 6147) or depressive symptoms (n = 6197) at intake. Anxiety and depressive symptoms were measured weekly during the first month of treatment. Three trajectories of anxiety symptoms (i.e., Persistent Moderate Anxiety Symptoms, Remitting Moderate Anxiety Symptoms, and Remitting Mild Anxiety Symptoms) and depressive symptoms (i.e., Increasing Moderate Depressive Symptoms, Persistent Moderate Depressive Symptoms, and Remitting Mild Depressive Symptoms) were identified. Women, younger individuals, and individuals who endorsed greater past month benzodiazepine use and depressive symptoms at intake were more likely to be in the Persistent Moderate Anxiety Symptoms trajectory relative to the Remitting Mild Anxiety Symptoms subgroup. Women, individuals who screened positive for anxiety at intake, and individuals reporting past month heroin use were more likely to be in the Increasing Moderate Depressive Symptoms trajectory relative to the Remitting Mild Depressive Symptom trajectory. Trajectories characterized by persistent moderate anxiety and depressive symptoms during the first month of treatment were more likely to drop out of treatment compared to individuals who reported low symptom levels. Findings indicate heterogeneity in the clinical course of anxiety and depressive symptoms among individuals in treatment for alcohol use and highlight that persistently high anxiety and depressive symptoms may pose an impediment to successful treatment completion. Results also demonstrate the importance of considering demographic and clinical characteristics at treatment intake as they may have significant implications for the unfolding of anxiety and depressive symptoms during treatment and subsequent outcomes.
我们研究了焦虑和抑郁症状的潜在轨迹是否与临床相关变量有关，包括寻求酒精使用治疗的个体的治疗脱落。参与者来自 78 个成瘾治疗中心，包括正在接受酒精治疗的个体、有治疗期间数据且在入组时筛查出焦虑（n=6147）或抑郁症状（n=6197）阳性的个体。焦虑和抑郁症状在治疗的第一个月每周测量一次。确定了焦虑症状（即持续中度焦虑症状、缓解中度焦虑症状和缓解轻度焦虑症状）和抑郁症状（即中度抑郁症状加重、持续中度抑郁症状和缓解轻度抑郁症状）的三个轨迹。与缓解轻度焦虑症状亚组相比，女性、年轻个体以及在入组时报告过去一个月使用苯二氮䓬类药物和抑郁症状更多的个体更有可能处于持续中度焦虑症状轨迹。女性、在入组时筛查出焦虑阳性的个体以及报告过去一个月使用海洛因的个体更有可能处于中度抑郁症状加重轨迹，而不是缓解轻度抑郁症状轨迹。与报告低症状水平的个体相比，在治疗的第一个月中持续存在中度焦虑和抑郁症状的个体更有可能退出治疗。研究结果表明，在接受酒精治疗的个体中，焦虑和抑郁症状的临床病程存在异质性，并强调持续存在的高焦虑和抑郁症状可能会对成功完成治疗构成障碍。研究结果还表明，在治疗开始时考虑人口统计学和临床特征的重要性，因为这些特征可能对治疗期间焦虑和抑郁症状的发展以及随后的结果产生重大影响。
