Vöckel Jasper, Sigrist Christine, Kaess Michael, Koenig Julian
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany.
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Germany.
J Affect Disord. 2023 Mar 1;324:129-135. doi: 10.1016/j.jad.2022.12.073. Epub 2022 Dec 29.
Depressive disorders (DD) are highly prevalent among adolescents. While up to 60 % do not respond to treatment, evidence on predictors of treatment non-response in this age group is mixed, impeding meaningful clinical implications. Drawing on a consecutive clinical cohort of adolescents with risk taking and self-injurious behavior, the present study aimed to identify predictors of treatment non-response for female DD in a naturalistic one year follow-up.
The sample comprised female adolescents with verified DD (n = 152). Patients underwent assessments at baseline (T0) and follow-up (T1). Sociodemographic factors (e.g., age), clinical measures (e.g., symptom severity, trauma), and treatment variables (e.g. number of psychotherapy sessions), were analyzed as potential predictors of treatment non-response in unadjusted analyses and analyses adjusting for treatment intensity and age at baseline. Treatment response was defined based on not fulfilling formal diagnosis for DD at follow-up (52.3 %; n = 80) or the 50 % decrease in self-reported depressive symptoms (21.1 %; n = 32) from T0 to T1.
Greater depressive and overall symptom severity, greater frequency of self-injuries, history of suicide attempts and history of childhood trauma at T0 were robustly associated with treatment non-response based on diagnostic interviews. Only a lower number of siblings was robustly associated with treatment non-response based on self-reports.
Findings may not generalize to other treatment settings.
Collectively, our results highlight overall symptom severity as significant predictor of treatment non-response in female adolescents with depression. Methodological differences (interviews versus self-reports) and potential implications from these findings for clinical practice are discussed.
抑郁症（DD）在青少年中极为普遍。虽然高达60%的患者对治疗无反应，但关于该年龄组治疗无反应预测因素的证据并不一致，这阻碍了有意义的临床应用。本研究基于一个连续的有冒险和自我伤害行为的青少年临床队列，旨在通过为期一年的自然随访确定女性抑郁症患者治疗无反应的预测因素。
样本包括确诊为DD的女性青少年（n = 152）。患者在基线（T0）和随访（T1）时接受评估。社会人口学因素（如年龄）、临床指标（如症状严重程度、创伤）和治疗变量（如心理治疗疗程数）在未经调整的分析以及调整治疗强度和基线年龄后的分析中，被作为治疗无反应的潜在预测因素进行分析。治疗反应的定义基于随访时未满足DD的正式诊断标准（52.3%；n = 80）或自我报告的抑郁症状从T0到T1下降50%（21.1%；n = 32）。
根据诊断访谈，T0时抑郁和总体症状更严重、自我伤害频率更高、有自杀未遂史和童年创伤史与治疗无反应密切相关。根据自我报告，只有兄弟姐妹数量较少与治疗无反应密切相关。
研究结果可能不适用于其他治疗环境。
总体而言，我们的结果突出了总体症状严重程度是女性青少年抑郁症治疗无反应的重要预测因素。讨论了方法学差异（访谈与自我报告）以及这些发现对临床实践的潜在影响。
